WorldWideScience

Sample records for patients requiring emergency

  1. Mesenteric panniculitis patients requiring emergency surgery: report of three cases.

    Science.gov (United States)

    Duman, Mustafa; Koçak, Osman; Fazli, Olgaç; Koçak, Cengiz; Atici, Ali Emre; Duman, Uğur

    2012-04-01

    Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. The small bowel mesentery is affected mostly. This process rarely involves the large intestine mesentery. Mesenteric panniculitis includes symptoms as abdominal pain, nausea and vomiting, diarrhea, constipation, and fever. In our cases, we had difficulty in the preoperative diagnosis as the clinical changes imitated an obstruction or ischemia of the small bowel. All the cases required emergency abdominal surgery and partial jejunal resection. The aim of this article was to present three cases of mesenteric panniculitis of the small bowel mesentery requiring emergency surgery together with a short review of the literature.

  2. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  3. Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department.

    Science.gov (United States)

    Turvani, Fabrizio; Pigozzi, Luca; Barutta, Letizia; Pivetta, Emanuele; Pizzolato, Elisa; Morello, Fulvio; Battista, Stefania; Moiraghi, Corrado; Montrucchio, Giuseppe; Lupia, Enrico

    2014-10-01

    Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED. We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the "Città della Salute e della Scienza di Torino" Hospital with a platelet count <150×10(9) PLTs/L, during four non-consecutive months. There were no exclusion criteria. The study included 1218 patients. The percentage of patients with severe (<50×10(9) PLTs/L) or very severe (<20×10(9) PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia. Our results suggest that the detection of a platelet count lower than 50×10(9) PLTs/L may help to identify patients with higher bleeding risk in the ED setting. Additional studies are required to evaluate whether, in this setting, thrombocytopenia may represent an independent risk factor for bleeding episodes and increased mortality.

  4. A comparison of alcohol positive and alcohol negative trauma patients requiring an emergency laparotomy.

    Science.gov (United States)

    Benson, Cedric; Weinberg, Janice; Narsule, Chaitan K; Brahmbhatt, Tejal S

    2018-07-01

    The effect of alcohol exposure on patients undergoing a laparotomy for trauma is unknown. The purpose of this study was to compare outcomes of morbidity and mortality between alcohol positive and alcohol negative trauma patients who required emergent laparotomies using the National Trauma Data Bank (NTDB). A retrospective database analysis was performed using 28,354 NTDB incident trauma cases, from 2007 through 2012, who had been tested for alcohol and who required abdominal operations (using ICD-9-CM procedure codes) within 24h of presentation. Variables used: age, gender, admission year, alcohol presence, ISS, GCS, injury type & mechanism, discharge status, hospital LOS, ICU stay, ventilator use, and hospital complications. In adjusted analyses, there were no statistically significant differences between the alcohol positive and alcohol negative cohorts when evaluating in-hospital mortality (OR, 0.93; 95% CI: 0.84-1.03), likelihood of earlier hospital discharge (HR, 1.02; 95% CI: 0.99-1.05), and the all-inclusive category of in-hospital complications (OR, 1.04; 95% CI: 0.97-1.12). After adjusting for age, gender, admission year, ISS, GCS, and injury mechanism, there were no major differences between the alcohol positive and alcohol negative cohorts when it came to in-hospital mortality, likelihood of earlier hospital discharge, and most of the in-hospital complications measured among adult trauma patients requiring emergency laparotomies. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    Science.gov (United States)

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2017-06-01

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?

    Science.gov (United States)

    Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree

    2018-02-01

    Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  7. Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care

    Directory of Open Access Journals (Sweden)

    Zhihong Feng

    2017-01-01

    Full Text Available We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients and those who did not (survival group; 336 patients. Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age (P<0.05 for all. With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II (P=1.519. Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

  8. REQUIREMENTS FOR IMAGE QUALITY OF EMERGENCY SPACECRAFTS

    Directory of Open Access Journals (Sweden)

    A. I. Altukhov

    2015-05-01

    Full Text Available The paper deals with the method for formation of quality requirements to the images of emergency spacecrafts. The images are obtained by means of remote sensing of near-earth space orbital deployment in the visible range. of electromagnetic radiation. The method is based on a joint taking into account conditions of space survey, characteristics of surveillance equipment, main design features of the observed spacecrafts and orbital inspection tasks. Method. Quality score is the predicted linear resolution image that gives the possibility to create a complete view of pictorial properties of the space image obtained by electro-optical system from the observing satellite. Formulation of requirements to the numerical value of this indicator is proposed to perform based on the properties of remote sensing system, forming images in the conditions of outer space, and the properties of the observed emergency spacecraft: dimensions, platform construction of the satellite, on-board equipment placement. For method implementation the authors have developed a predictive model of requirements to a linear resolution for images of emergency spacecrafts, making it possible to select the intervals of space shooting and get the satellite images required for quality interpretation. Main results. To verify the proposed model functionality we have carried out calculations of the numerical values for the linear resolution of the image, ensuring the successful task of determining the gross structural damage of the spacecrafts and identifying changes in their spatial orientation. As input data were used with dimensions and geometric primitives corresponding to the shape of deemed inspected spacecrafts: Resurs-P", "Canopus-B", "Electro-L". Numerical values of the linear resolution images have been obtained, ensuring the successful task solution for determining the gross structural damage of spacecrafts.

  9. [Should hospitalization be required after the emergency discharge of patients with borderline personality disorder who have attempted suicide (FRENCH CRISIS cohort)?].

    Science.gov (United States)

    Cailhol, L; Riedi, G; Mathur, A; Czapla, P; Charpentier, S; Genestal, M; Birmes, P

    2014-09-01

    Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. There is a high prevalence of BPD patients among those admitted to the emergency department for suicide attempts. However, little empirical research exists to assist clinicians in deciding whether to hospitalize a suicidal patient. Some authors have argued that hospitalization does not prevent suicide and could actually harm these patients, thereby leading to psychosocial regression. Parasuicidal behaviors could be reinforced by the attention given during hospitalization. Our purpose was to determine whether the hospitalization of suicidal patients who have a high risk of BPD after discharge from the emergency department is associated with a recurrence of suicidal behavior at 6months. We designed a prospective study, acquiring patients from three emergency hospitals. The participants were suicidal subjects admitted for voluntary drug intoxication and were 18years of age or older. The participants completed the Personality Disorder Questionnaire (PDQ-4+) to assess BPD symptomatology. Information on the recurrence of suicidal behavior at 6months was obtained by interview of patients and the review of the charts from the 3 hospitals involved in the study. Other assessments included the BDI-13 (severity of depression), the Hopelessness Scale (hopelessness), the TAS-20 (alexythymia), the AUDIT (alcohol disorder) and the MINI (axis I disorders). A total of 606 subjects admitted for a suicide attempt participated in this study. A total of 320 (52.8 %) of the subjects completed the PDQ-4+. The sample was divided into three groups: participants at high risk of having at least one BPD (n=197), a group at high risk of having at least one non-BPD PD (n=84) and a group with low risk of having a PD (n=39). Hospitalization following an emergency was not associated with a recurrence of suicide attempts at 6months among patients at high risk of BPD. A logistical

  10. Some Qualitative Requirements for Testing of Nuclear Emergency Response Robots

    International Nuclear Information System (INIS)

    Eom, Heungseop; Cho, Jai Wan; Choi, Youngsoo; Jeong, Kyungmin

    2014-01-01

    Korea Atomic Energy Research Institute (KAERI) is carrying out the project 'Development of Core Technology for Remote Response in Nuclear Emergency Situation', and as a part of the project, we are studying the reliability and performance requirements of nuclear emergency response robots. In this paper, we described some qualitative requirements for testing of nuclear emergency response robots which are different to general emergency response robots. We briefly introduced test requirements of general emergency response robots and described some qualitative aspects of test requirements for nuclear emergency response robots. When considering an immature field-robot technology and variety of nuclear emergency situations, it seems hard to establish quantitative test requirements of these robots at this time. However, based on studies of nuclear severe accidents and the experience of Fukushima NPP accident, we can expect some test requirements including quantitative ones for nuclear emergency response robots

  11. 12 CFR 204.9 - Emergency reserve requirement.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Emergency reserve requirement. 204.9 Section... RESERVE REQUIREMENTS OF DEPOSITORY INSTITUTIONS (REGULATION D) § 204.9 Emergency reserve requirement. (a..., additional reserve requirements on depository institutions at any ratio on any liability upon a finding by at...

  12. 32 CFR 732.16 - Emergency care requirements.

    Science.gov (United States)

    2010-07-01

    ... sepsis. (9) Any other obstetrical condition that, by definition, constitutes an emergency circumstance. ... 32 National Defense 5 2010-07-01 2010-07-01 false Emergency care requirements. 732.16 Section 732... MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.16 Emergency care requirements...

  13. 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

  14. Emergency Evacuation Management Requirements and Concepts

    Science.gov (United States)

    1981-05-01

    state government would assert positive leadership , motivate the public, and issue emergency directives. In other words, local officials assume...feasible way to implement such a program is for FEMA to assume leadership through subordinate units considered relevant and prestigous. Active...Supply and Organizations and recruits Organizations control per- D&C and organizatins ronitor Distribution control operations. ations. and reallocate

  15. Emergency thoracic surgery in elderly patients

    Science.gov (United States)

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

  16. The emergency patient's participation in medical decision-making.

    Science.gov (United States)

    Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

    2016-09-01

    The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

  17. Spatial data requirements for emergency response

    International Nuclear Information System (INIS)

    Walker, H.

    1985-01-01

    The Atmospheric Release Advisory Capability (ARAC) provides real-time assessments of the consequences resulting from an atmospheric radioactive material. In support of this operation, a system has been created which integrates numerical models, data acquisition systems, data analysis techniques, and professional staff. Components of this system rely to large degree on spatial data of various kinds. Of particular importance is the rapid generation of digital terrain models for any area in the continental U.S. The digital terrain models are used as input to atmospheric models and serve to familiarize assessors to new areas by presenting the terrain surface as a graphical image. In addition, base map data (roads, rivers, political boundaries) must also be supplied as an overlay to ARAC graphical products. A terrain data base and an associated acquisition system have been developed that provide the required terrain data within ten minutes. This terrain data base was derived from the Defense Mapping Ageny's planar data. A digital base map data base is currently being developed from the U.S. Geographical Survey's 1:2,000,000 Digital Line Graph data as well as their Geographic Names Information System. This base map data base improves ARAC's response to its mapping needs anywhere in the continental U.S

  18. ALWR utility requirements - A technical basis for updated emergency planning

    International Nuclear Information System (INIS)

    Leaver, David E.W.; DeVine, John C. Jr.; Santucci, Joseph

    2004-01-01

    U.S. utilities, with substantial support from international utilities, are developing a comprehensive set of design requirements in the form of a Utility Requirements Document (URD) as part of an industry wide effort to establish a technical foundation for the next generation of light water reactors. A key aspect of the URD is a set of severe accident-related design requirements which have been developed to provide a technical basis for updated emergency planning for the ALWR. The technical basis includes design criteria for containment performance and offsite dose during severe accident conditions. An ALWR emergency planning concept is being developed which reflects this severe accident capability. The main conclusion from this work is that the likelihood and consequences of a severe accident for an ALWR are fundamentally different from that assumed in the technical basis for existing emergency planning requirements, at least in the U.S. The current technical understanding of severe accident risk is greatly improved compared to that available when the existing U.S. emergency planning requirements were established nearly 15 years ago, and the emerging ALWR designs have superior core damage prevention and severe accident mitigation capability. Thus, it is reasonable and prudent to reflect this design capability in the emergency planning requirements for the ALWR. (author)

  19. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  20. Establishing functional requirements for emergency management information systems

    Energy Technology Data Exchange (ETDEWEB)

    Reed, J.H.; Rogers, G.O.; Sorensen, J.H.

    1991-01-01

    The advancement of computer technologies has led to the development of a number of emergency management information systems (e.g., EIS, CAMEO, IEMIS). The design of these systems has tended to be technologically driven rather than oriented to meeting information management needs during an emergency. Of course, emergency management needs vary depending on the characteristics of the emergency. For example, in hurricanes, onset is typically slow enough to allow emergency managers to simulate evacuations dynamically while in chemical disasters onset may be sufficiently rapid to preclude such simulation(s). This paper describes a system design process in which the analysis of widely recognized emergency management functions was used to identify information requirements and the requisite software and hardware capabilities to deal with rapid onset, low probability, high consequence events. These requirements were then implemented as a prototype emergency management system using existing hardware and software to assure feasibility. Data, hardware, and software requirements were further developed, refined, and made more concrete through an iterative prototyping effort. This approach focuses attention directly on meeting emergency management information needs while avoiding unneeded technological innovations. 10 refs., 4 figs., 1 tab.

  1. Identifying and Managing Engineering Design Requirements for Emerging Markets

    DEFF Research Database (Denmark)

    Li, Xuemeng

    , especially for those companies originally from developed markets, to acquire an in-depth understanding of particular design requirements in emerging markets in order to adapt both company products and approaches in such contexts. Prior studies on the identification and management of design requirements have...... predominantly been conducted in the context of developed countries and relatively affluent markets. Emerging markets are distinct from developed markets in terms of numerous contextual factors, e.g., regulatory environments and competitive landscapes. These factors influence the requirement identification...... attention. There is a need for an overview of different perspectives in requirement identification for manufacturing companies and their corresponding assessments in the context of emerging markets. Therefore, this research project is motivated to 1) investigate the process of identifying and managing...

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

    Science.gov (United States)

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

    2015-12-09

    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.

  3. Dimensioning of emergency condensers in accordance with safety requirements

    Energy Technology Data Exchange (ETDEWEB)

    Palavecino, C [SIEMENS, Energieerzeugung, Offenbach (Germany)

    1996-12-01

    The emergency condensers are heat exchangers consisting of a parallel arrangement of horizontal U-tubes between two common heads. The tope header is connected via piping to the reactor vessel steam space, while the lower header is connected to the reactor vessel below the reactor vessel water level. The heat exchangers are located in a pool filled with cold water. The emergency condensers and the reactor vessel thus form a system of communicating pipes. At normal reactor water level, the emergency condensers are flooded with cold, non-flowing water. No heat transfer takes place in this condition. If there is a drop in the reactor water level, the heat exchanging surfaces are gradually uncovered and the incoming steam condenses on the cold surfaces. The cold condensate in returned to the reactor vessel. In this way, heat is removed from the reactor vessel and water simultaneously supplied to the reactor vessel. This means that the emergency condensers function as a heat removal system while at the same time serving as HP and LP coolant injection systems. The emergency condensers operate with the highest possible degree of passivity imaginable, namely through a drop in the reactor vessel water level alone, requiring neither control systems nor power supply. The design of the emergency condensers must meet the requirements dictated by the thermal and the hydraulic conditions. Taking into consideration a redundancy degree of N + 2, a specific thermal rating of 63 MW per emergency condenser results for a reactor with an output of 2778 MW. The total performance of the emergency condenser system in thus 252 MW, or 9.1% of reactor output. The probability of failure of the emergency condenser of Siemens SWR 1000 is approximately 10{sup -4} per demand, while that of the older emergency condenser designs is approximately 2 to 3 x 10{sup -3} per demand. (author). 7 figs, 2 tabs.

  4. How Much Time Do Unhospitalized Patients Applying for Emergency Services Stay in Emergency Department

    Directory of Open Access Journals (Sweden)

    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.

  5. Emergency general surgery in the geriatric patient.

    Science.gov (United States)

    Desserud, K F; Veen, T; Søreide, K

    2016-01-01

    Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  6. 41 CFR 101-26.607-3 - Emergency requirements.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Emergency requirements. 101-26.607-3 Section 101-26.607-3 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND...

  7. Neurologic emergencies in HIV-negative immunosuppressed patients.

    Science.gov (United States)

    Guzmán-De-Villoria, J A; Fernández-García, P; Borrego-Ruiz, P J

    HIV-negative immunosuppressed patients comprise a heterogeneous group including transplant patients, patients undergoing treatment with immunosuppressors, uremic patients, alcoholics, undernourished patients, diabetics, patients on dialysis, elderly patients, and those diagnosed with severe or neoplastic processes. Epileptic seizures, focal neurologic signs, and meningoencephalitis are neurologic syndromes that require urgent action. In most of these situations, neuroimaging tests are necessary, but the findings can be different from those observed in immunocompetent patients in function of the inflammatory response. Infectious disease is the first diagnostic suspicion, and the identification of an opportunistic pathogen should be oriented in function of the type and degree of immunosuppression. Other neurologic emergencies include ischemic stroke, cerebral hemorrhage, neoplastic processes, and pharmacological neurotoxicity. This article reviews the role of neuroimaging in HIV-negative immunodepressed patients with a neurologic complication that requires urgent management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

    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

  9. Emergency department management of patients with thermal burns [digest].

    Science.gov (United States)

    Tolles, Juliana; Gupta, Nachi; Nusbaum, Jeffrey

    2018-02-01

    Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care. Special populations, including children and pregnant women, require additional treatment considerations. Referral to specialized burn care for select patients is necessary to improve long-term outcomes. This article reviews thermal burn classification and evidence-based treatment strategies. [Points & Pearls is a digest of Emergency Medicine Practice.].

  10. Employer Requirements to Work during Emergency Responses: Key Ethics Considerations.

    Science.gov (United States)

    Rutkow, Lainie; Taylor, Holly A; Powell, Tia

    2017-03-01

    Local health departments and their employees are at the forefront of emergency preparedness and response. Yet, recent studies have found that some local public health workers are unwilling to report to work in a variety of disaster scenarios. This can greatly compromise a response, as many local health departments need "all hands on deck" to effectively meet increased demands. To address these concerns, local health departments have employed varied policy strategies to ensure that employees do report to work. After describing different approaches taken by local health departments throughout the United States, we briefly identify and explore key ethics considerations that arise for local health departments when employees are required to report to work for emergency responses. We then discuss how these ethics considerations may inform local health department practices intended to promote a robust emergency response.

  11. Risk stratification in emergency patients by copeptin

    DEFF Research Database (Denmark)

    Iversen, Kasper; Gøtze, Jens P; Dalsgaard, Morten

    2014-01-01

    BACKGROUND: Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the pre...

  12. 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...

  13. 78 FR 31769 - Accessible Emergency Information; Apparatus Requirements for Emergency Information and Video...

    Science.gov (United States)

    2013-05-24

    ... and equipment and better access video programming.'' \\7\\ \\7\\ H.R. Rep. No. 111-563, 111th Cong., 2d... Video Accessibility Act of 2010 (``CVAA''), the Commission adopts rules requiring video programming distributors and video programming providers (including program owners) to make televised emergency information...

  14. Forecasting the Emergency Department Patients Flow.

    Science.gov (United States)

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

    2016-07-01

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

  15. Definition of areas requiring criticality alarm annunciation and emergency control

    International Nuclear Information System (INIS)

    Hobson, J.M.

    1988-01-01

    The design of fissile material handling at British Nuclear Fuels plc requires the provision of a criticality incident detection system unless a specific case for omission can be formally made. Where such systems are provided, the 100 mSv contour resulting from a reference criticality incident must be restricted to an area of administrative control within which it is reasonably practicable to provide alarm annunciation and for which emergency arrangements can be defined. For typical reprocessing plant applications, the definition of these areas, and their restriction by provision of shielding where necessary, potentially requires a very large number of three dimensional neutron transport calculations in complex geometries. However, by considering the requirements and nature of this assessment, simple generic methods have been developed and justified. Consequently, rapid and inexpensive assessments of control areas can be carried out

  16. Prototyping and validating requirements of radiation and nuclear emergency plan simulator

    Energy Technology Data Exchange (ETDEWEB)

    Hamid, AHA., E-mail: amyhamijah@nm.gov.my [Malaysian Nuclear Agency (NM), Bangi, 43000 Kajang, Selangor (Malaysia); Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, 81310 Johor Bahru, Johor (Malaysia); Rozan, MZA.; Ibrahim, R.; Deris, S.; Selamat, A. [Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, 81310 Johor Bahru, Johor (Malaysia)

    2015-04-29

    Organizational incapability in developing unrealistic, impractical, inadequate and ambiguous mechanisms of radiological and nuclear emergency preparedness and response plan (EPR) causing emergency plan disorder and severe disasters. These situations resulting from 65.6% of poor definition and unidentified roles and duties of the disaster coordinator. Those unexpected conditions brought huge aftermath to the first responders, operators, workers, patients and community at large. Hence, in this report, we discuss prototyping and validating of Malaysia radiation and nuclear emergency preparedness and response plan simulation model (EPRM). A prototyping technique was required to formalize the simulation model requirements. Prototyping as systems requirements validation was carried on to endorse the correctness of the model itself against the stakeholder’s intensions in resolving those organizational incapability. We have made assumptions for the proposed emergency preparedness and response model (EPRM) through the simulation software. Those assumptions provided a twofold of expected mechanisms, planning and handling of the respective emergency plan as well as in bringing off the hazard involved. This model called RANEPF (Radiation and Nuclear Emergency Planning Framework) simulator demonstrated the training emergency response perquisites rather than the intervention principles alone. The demonstrations involved the determination of the casualties’ absorbed dose range screening and the coordination of the capacity planning of the expected trauma triage. Through user-centred design and sociotechnical approach, RANEPF simulator was strategized and simplified, though certainly it is equally complex.

  17. Prototyping and validating requirements of radiation and nuclear emergency plan simulator

    International Nuclear Information System (INIS)

    Hamid, AHA.; Rozan, MZA.; Ibrahim, R.; Deris, S.; Selamat, A.

    2015-01-01

    Organizational incapability in developing unrealistic, impractical, inadequate and ambiguous mechanisms of radiological and nuclear emergency preparedness and response plan (EPR) causing emergency plan disorder and severe disasters. These situations resulting from 65.6% of poor definition and unidentified roles and duties of the disaster coordinator. Those unexpected conditions brought huge aftermath to the first responders, operators, workers, patients and community at large. Hence, in this report, we discuss prototyping and validating of Malaysia radiation and nuclear emergency preparedness and response plan simulation model (EPRM). A prototyping technique was required to formalize the simulation model requirements. Prototyping as systems requirements validation was carried on to endorse the correctness of the model itself against the stakeholder’s intensions in resolving those organizational incapability. We have made assumptions for the proposed emergency preparedness and response model (EPRM) through the simulation software. Those assumptions provided a twofold of expected mechanisms, planning and handling of the respective emergency plan as well as in bringing off the hazard involved. This model called RANEPF (Radiation and Nuclear Emergency Planning Framework) simulator demonstrated the training emergency response perquisites rather than the intervention principles alone. The demonstrations involved the determination of the casualties’ absorbed dose range screening and the coordination of the capacity planning of the expected trauma triage. Through user-centred design and sociotechnical approach, RANEPF simulator was strategized and simplified, though certainly it is equally complex

  18. Prototyping and validating requirements of radiation and nuclear emergency plan simulator

    Science.gov (United States)

    Hamid, AHA.; Rozan, MZA.; Ibrahim, R.; Deris, S.; Selamat, A.

    2015-04-01

    Organizational incapability in developing unrealistic, impractical, inadequate and ambiguous mechanisms of radiological and nuclear emergency preparedness and response plan (EPR) causing emergency plan disorder and severe disasters. These situations resulting from 65.6% of poor definition and unidentified roles and duties of the disaster coordinator. Those unexpected conditions brought huge aftermath to the first responders, operators, workers, patients and community at large. Hence, in this report, we discuss prototyping and validating of Malaysia radiation and nuclear emergency preparedness and response plan simulation model (EPRM). A prototyping technique was required to formalize the simulation model requirements. Prototyping as systems requirements validation was carried on to endorse the correctness of the model itself against the stakeholder's intensions in resolving those organizational incapability. We have made assumptions for the proposed emergency preparedness and response model (EPRM) through the simulation software. Those assumptions provided a twofold of expected mechanisms, planning and handling of the respective emergency plan as well as in bringing off the hazard involved. This model called RANEPF (Radiation and Nuclear Emergency Planning Framework) simulator demonstrated the training emergency response perquisites rather than the intervention principles alone. The demonstrations involved the determination of the casualties' absorbed dose range screening and the coordination of the capacity planning of the expected trauma triage. Through user-centred design and sociotechnical approach, RANEPF simulator was strategized and simplified, though certainly it is equally complex.

  19. Clarification of TMI action plan requirements. Requirements for emergency response capability

    International Nuclear Information System (INIS)

    1983-01-01

    This document, Supplement 1 to NUREG-0737, is a letter from D. G. Eisenhut, Director of the Division of Licensing, NRR, to licensees of operating power reactors, applicants for operating licenses, and holders of construction permits forwarding post-TMI requirements for emergency response capability which have been approved for implementation. On October 30, 1980, the NRC staff issued NUREG-0737, which incorporated into one document all TMI-related items approved for implementation by the Commission at that time. In this NRC report, additional clarification is provided regarding Safety Parameter Display Systems, Detailed Control Room Design Reviews, Regulatory Guide 1.97 (Revision 2) - Application to Emergency Response Facilities, Upgrade of Emergency Operating Procedures, Emergency Response Facilities, and Meteorological Data

  20. [Characteristics of emergency poisoning cases in elderly versus younger patients].

    Science.gov (United States)

    Supervía Caparrós, August; Pallàs Villaronga, Oriol; Clemente Rodríguez, Carlos; Aranda Cárdenas, María Dolores; Pi-Figueras Valls, María; Cirera Lorenzo, Isabel

    2017-10-01

    To compare cases of poisoning according to age to detect differences in frequency of visits to the emergency department, patient characteristics, case management, and immediate outcome in terms of related mortality. Descriptive study of a retrospective series of patients who visited a university hospital emergency department for treatment of poisoning between 2009 and 2014. We collected patient characteristics and data related to the event, case management, and poisoning-related death. Patients were grouped according to age (cut-off 65 y). Of a total of 3847 poisoning episodes, 341 (8.9%) were in patients aged 65 years or older. The percentage of women among these older patients (61.3%) was greater than among younger patients (36.3%; P<.001). Poisoning was accidental in older patients more often than younger ones (64.4% vs 9.5%, respectively; P<.001), occurred more often in the home (82.1% vs 37%, P<.001), and more often required active treatment (73.3% vs 57.4%; P<.001) and admission to hospital (21.4% vs 7.3%, P<.001). The related mortality rate was also higher in the older patients (2.1% vs 0.1% in younger patients, P<.001). The percentage of poisonings in patients aged 65 years or older is not negligible. Poisoning in patients of advanced age tends to be accidental and take place in the home. Older patients more often require active treatment and hospital admission; poisoning-related death is more common in older patients than younger ones.

  1. [The drug abuse patient as emergency].

    Science.gov (United States)

    Kessler, R; Ryser, D H

    1991-01-15

    Acute drug intoxication is a medical emergency considering its potential interference with vital functions. All 157 cases with drug overdose admitted to the emergency department of the "Inselspital" in Berne over 183 days between July 1989 and June 1990 were analyzed retrospectively. In the vast majority of cases heroin overdose was involved. In mixed poisonings with heroin mostly flunitrazepam and alcohol contributed to the clinical picture, less commonly cocaine. There were very few intoxications with cocaine alone. A practical approach to the management of patients with certain or suspected drug intoxication presenting with coma and depressed respiration is proposed. In the therapy of acute intoxications with opiates and benzodiazepines there are specific antagonists available. In contrast, therapy of cocaine overdose remains symptomatic. The medical complications of acute heroin and cocaine intoxications are discussed separately.

  2. Emerging versions of patient involvement with Patient Reported Outcomes

    DEFF Research Database (Denmark)

    Langstrup, Henriette

    It is a central argument in the growing Danish PRO-arena, that a large-scale collection of PRO from patients in the Danish Healthcare system will pave the way for more genuine patient involvement in clinical decision-making, quality management and governance of the health services. In this paper I...... discuss how patient involvement is being (re)configured when increasingly connected to national visions of participatory healthcare. A central discussion centers on ‘meaningful use’ of patient-generated data promoting patients’ expectations and experiences as a criterion for how to proceed...... with the national use of PRO. But how do assumptions of what constitutes meaning for patients interact with the kinds of roles that patients are expected to take on with PROtools? What forms of participation are assumed to be meaningful and thus good and which are not? In sketching emerging versions of patient...

  3. Composition and fundamental requirements of nuclear emergency response monitoring equipment

    International Nuclear Information System (INIS)

    Lai Yongfang; Huang Weiqi; Wang Yonghong

    2009-01-01

    Nuclear emergency monitoring equipment is concrete foundation for accomplishing radiation monitoring in nuclear or radiation accidents. Based on technical report: Generic procedures for monitoring in a nuclear or radiological emergency published by IAEA in 1999, this paper presents the main task and composition of nuclear emergency monitoring briefly, and then the basic equipment and trends of nuclear emergency monitoring equipment is put forward in detail, which is useful to construction and reinforcement of our nuclear emergency monitoring. (authors)

  4. Pain management: association with patient satisfaction among emergency department patients.

    Science.gov (United States)

    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.

  5. Emergency surgery on mentally impaired patients: standard in consenting

    Directory of Open Access Journals (Sweden)

    Mihai Paduraru

    2018-04-01

    Full Text Available Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient.

  6. The Profile of Neurology Patients Evaluated in the Emergency Department

    OpenAIRE

    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...

  7. Emergency Department Patient Burden from an Electronic Dance Music Festival.

    Science.gov (United States)

    Chhabra, Neeraj; Gimbar, Renee P; Walla, Lisa M; Thompson, Trevonne M

    2018-04-01

    Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals. This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED. Medical charts of patients presenting to one HCF from an EDM festival were reviewed for substances used, ED LOS, and sedative medications administered. Additionally, preparedness techniques are described. Over the 3-day festival, 28 patients presented to the ED (median age 21 years; range 18-29 years). Twenty-five had complaints related to substance use including ethanol (n = 18), "molly" or "ecstasy" (n = 13), and marijuana (n = 8). Three patients required intensive care or step-down unit admission for endotracheal intubation, rhabdomyolysis, and protracted altered mental status. The median LOS for discharged patients was 265 min (interquartile range 210-347 min). Eleven patients required the use of sedative medications, with cumulative doses of 42 mg of lorazepam and 350 mg of ketamine. All patients presented within the hours of 5:00 pm and 2:15 am. The majority of ED visits from an EDM festival were related to substance use. ED arrival times clustered during the evening and were associated with prolonged LOS. Few patients required hospital admission, but admitted patients required high levels of care. HCFs should use these data as a guide in planning for future events. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. The impact of an emergency fee increase on the composition of patients visiting emergency departments.

    Science.gov (United States)

    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.

  9. The impact of psychiatric patient boarding in emergency departments.

    Science.gov (United States)

    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.

  10. The Impact of Psychiatric Patient Boarding in Emergency Departments

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

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

  11. Emergency nurses' knowledge and self-rated practice skills when caring for older patients in the Emergency Department.

    Science.gov (United States)

    Rawson, Helen; Bennett, Paul N; Ockerby, Cherene; Hutchinson, Alison M; Considine, Julie

    2017-11-01

    Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia. Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  12. [When should a patient with abdominal pain be referred to the emergency ward?].

    Science.gov (United States)

    de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

    2010-08-25

    When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral.

  13. [Compliance with the requirements of paediatric emergency departments in Spain: a self-assessment survey].

    Science.gov (United States)

    Sánchez Etxaniz, J; Luaces I Cubells, C; Benito Fernández, J

    2011-08-01

    Paediatric emergency medicine in Spain is practiced in differently configured departments, staffing and organisation. Our goal was to determine the situation in Paediatric Emergency Departments (PED) and their adaptation to the quality standards proposed by the Spanish Society of Paediatric Emergencies. A self-assessment questionnaire on standards performance was sent to 47 PED directors by e-mail. It consisted of 101 items, 69 considered mandatory. According to the fulfilment of these 69 items 4 PED groups were selected: group I: in the best position (met 69), group II: requiring minimal changes (meeting 62-68), group III: requiring major changes (meeting 41-61); group IV: requiring a lot of major changes (meeting less than 41). Thirty nine questionnaires were completed in full. The PED included in the study tended to an average of 35310 annual emergencies (5000-115000). No PED was included in group I, 6 in II 27 in III and 6 in IV. There was a tendency towards higher compliance with standards in larger PED, but there was no significant relationship between the number of emergencies and the number of items fulfilled. 1. Staffing and architectural and organizational aspects may not be adequate to achieve optimal patient outcome in many PED in Spain. This fact does not appear to be related to the annual patient census. 2. The areas for improvement mainly affect functional issues that must be undertaken by those responsible. 3. A significant number of PED have serious architectural and staffing deficiencies, which would require economic measures by their managers. 4. Our self-assessment questionnaire identifies improvement actions. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. Nurse management skills required at an emergency care unit

    OpenAIRE

    Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth

    2013-01-01

    Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...

  15. Critical Infrastructure Awareness Required by Civil Emergency Planning

    NARCIS (Netherlands)

    Luiijf, H.A.M.; Klaver, M.H.A.

    2005-01-01

    Modern societies are increasingly dependent on a set of critical products and services which comprise the Critical Infrastructure (CI). This makes Critical infrastructures increasingly important as a planning factor in case of emergencies. For that reason, we studied a number of emergencies and a

  16. Emergency Response Capability Baseline Needs Assessment - Requirements Document

    Energy Technology Data Exchange (ETDEWEB)

    Sharry, J A

    2016-10-04

    This document was prepared by John A. Sharry, LLNL Fire Marshal and LLNL Division Leader for Fire Protection and reviewed by LLNL Emergency Management Department Head James Colson. The document follows and expands upon the format and contents of the DOE Model Fire Protection Baseline Capabilities Assessment document contained on the DOE Fire Protection Web Site, but only addresses emergency response.

  17. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...

  18. Postanesthesia emergence in patients with post-traumatic stress disorder.

    Science.gov (United States)

    Umholtz, Matthew; Cilnyk, John; Wang, Christopher K; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D

    2016-11-01

    Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs). Retrospective cohort. Postoperative recovery area. Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected. The patients were grouped on the basis of previous diagnosis of PTSD. A total of 317 patients were identified with a positive history of PTSD and were compared to 1446 patients without such a history for the occurrence of EDL in the postanesthesia care unit (PACU) as the primary endpoint. Duration of stay in PACU in minutes and the frequency of hospital admission were the secondary endpoints. Multivariate binary logistic regression analysis was performed to identify the predictors of EDL among the veteran population. Emergence delirium was reported in 37 cases (2.1%) after general anesthesia. Fifteen (4.7%) of 317 patients with PTSD and 22 (1.5%) of 1446 patients without history of PTSD demonstrated symptoms related to EDL in the PACU (P=.002). After propensity matching, there were 8 patients with EDL in the PTSD group whereas there were only 2 patients with EDL among controls. Posttraumatic stress disorder was also an independent predictor of EDL in multivariate analysis with an odds ratio of 6.66 and a 95% confidence interval of 2.04 to 21.72 (P=.002). Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder. Published by Elsevier Inc.

  19. Errors in imaging patients in the emergency setting.

    Science.gov (United States)

    Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

    2016-01-01

    Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

  20. Energy Requirements in Critically Ill Patients

    Science.gov (United States)

    2018-01-01

    During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.

  1. Energy Requirements in Critically Ill Patients.

    Science.gov (United States)

    Ndahimana, Didace; Kim, Eun-Kyung

    2018-04-01

    During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.

  2. Emergency department team communication with the patient: the patient's perspective.

    Science.gov (United States)

    McCarthy, Danielle M; Ellison, Emily P; Venkatesh, Arjun K; Engel, Kirsten G; Cameron, Kenzie A; Makoul, Gregory; Adams, James G

    2013-08-01

    Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication. The objective of this study was to determine patients' perceptions of their ED team's communication skills. This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded "excellent." Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census). There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % "excellent") ranged from 50.0% to 76.1%. The highest-scoring items were "let me talk without interruptions" (76.1%), "talked in terms I could understand" (75.2%), and "treated me with respect" (74.3%). The lowest-scoring item was "encouraged me to ask questions" (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED. The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    Science.gov (United States)

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  4. Emergency management in patients with late hemorrhage after pancreatoduodenectomy for a periampullary tumor

    NARCIS (Netherlands)

    Jilesen, Anneke P. J.; Tol, Johanna A. M. G.; Busch, Olivier R. C.; van Delden, Otto M.; van Gulik, Thomas M.; Nieveen van Dijkum, Els J. M.; Gouma, Dirk J.

    2014-01-01

    The mortality rate due to late hemorrhage after surgery for periampullary tumors is high, especially in patients with anastomotic leakage. Patients usually require emergency intervention for late hemorrhage. In this study patients with late hemorrhage and their outcomes were analyzed. Furthermore,

  5. Patient expectations of emergency dental services: a qualitative interview study.

    Science.gov (United States)

    Anderson, R

    2004-09-25

    To describe the expectations of walk-in patients seeking emergency dental care out-of-hours. Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis. Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend. In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological--especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary. Emergency dental services, some of which are still dominantly treatment-focused, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group.

  6. Basic management of medical emergencies: recognizing a patient's distress.

    Science.gov (United States)

    Reed, Kenneth L

    2010-05-01

    Medical emergencies can happen in the dental office, possibly threatening a patient's life and hindering the delivery of dental care. Early recognition of medical emergencies begins at the first sign of symptoms. The basic algorithm for management of all medical emergencies is this: position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D). The dentist places an unconscious patient in a supine position and comfortably positions a conscious patient. The dentist then assesses airway, breathing and circulation and, when necessary, supports the patient's vital functions. Drug therapy always is secondary to basic life support (that is, PABCD). Prompt recognition and efficient management of medical emergencies by a well-prepared dental team can increase the likelihood of a satisfactory outcome. The basic algorithm for managing medical emergencies is designed to ensure that the patient's brain receives a constant supply of blood containing oxygen.

  7. Nutritional requirements of the critically ill patient.

    Science.gov (United States)

    Chan, Daniel L

    2004-02-01

    The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.

  8. The Effectiveness of Ultrasonography in Detecting Emergent Pediatric Pathologies and Requirement for Additional Imaging Techniques: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Betül Tiryaki Baştuğ

    2018-04-01

    Full Text Available Introduction: In emergency cases, ultrasonography is used in guiding resuscitation, to provide procedural guidance, and confirm a clinical diagnosis. In addition, it may prevent unnecessary exposure of the patient to ionizing radiation and risks caused by transporting the patient away from monitoring. This paper aimed to evaluate the effectiveness of ultrasonography in detecting emergent pediatric pathologies in a state hospital radiology unit, and to identify whether additional imaging techniques, such as computed tomography, were required. Methods: This study was designed as a retrospective investigation. A group of 536 patients were randomly selected from 1.401 pediatric patients who underwent ultrasonography for non-traumatic emergent pathologies between 2015 and 2016. Results: Of the 536 patients, 46 were diagnosed with appendicitis, 14 with pathologies of the urinary system, 1 with ileus, 29 with mesenteric lymphadenitis, 4 with intussusception, 3 with ovarian cyst rupture, 1 with ovarian torsion, and 32 with scrotal pathologies. Computed tomography was performed for 20 patients. Ureteral calculi and appendicitis were confirmed by computed tomography in 5 and 14 patients, respectively, after being identified as secondary findings by ultrasonography. In 1 patient, ileus was verified by computed tomography. The sensitivity of ultrasonography was determined to be 85.7%. Only 14% of patients were not given definite pathological diagnoses by ultrasonography alone. Subsequent computed tomography for verifying secondary findings detected by ultrasonography was essential in only 20 patients. Conclusion: Our results promote the use of ultrasonography as the initial imaging test for evaluating pediatric patients with suspected emergency pathologies.

  9. Rights of patients required in a public service ombudsman

    Directory of Open Access Journals (Sweden)

    Maristela Santini Martins

    2015-07-01

    Full Text Available Objective: analyzing the rights of patients required in a public service ombudsmen. Methods: an exploratory, descriptive study of documentary research. 109 complaint forms coming from the basic network were analyzed, related to 12 Basic Health Units located within the Southern Health Technical Supervision. Results: grouped into four categories of required rights: access to goods and services (62.4% being, access to specialized exams (28.7%, access to consultations (16.6%, referral to a specialist (5.7%, referral for urgent/emergency cases (1.3%, monitoring through home visits (7.6%, guaranteed medications (2.5%. Quality of health services (36.9% divided into: decent, considerate and respectful care (26.8%, guidance/clarification (9.6%, and public disclosure of government programs (0.6% and adequate infrastructure (0.6%. Conclusion: the rights that patients required are related to access, quality, treatment and adequate infrastructure.

  10. 40 CFR 355.12 - What quantities of extremely hazardous substances trigger emergency planning requirements?

    Science.gov (United States)

    2010-07-01

    ... EMERGENCY PLANNING AND NOTIFICATION Emergency Planning Who Must Comply § 355.12 What quantities of extremely... 40 Protection of Environment 27 2010-07-01 2010-07-01 false What quantities of extremely hazardous substances trigger emergency planning requirements? 355.12 Section 355.12 Protection of Environment...

  11. 75 FR 52753 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2010-08-27

    ... therefore submitting a revised data collection form for emergency clearance. The definition of subsidized... Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: TANF Emergency Fund Subsidized Employment Report, Form OFA- 200. OMB No.: New Collection. Description...

  12. 75 FR 32473 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2010-06-08

    ... a TANF Emergency Fund award. The definition of subsidized employment used for this collection is the... Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: TANF Emergency Fund Subsidized Employment Report, Form OFA 200. OMB No.: New Collection. Description...

  13. Development of CSA N1600-14: general requirements for nuclear emergency management programs

    Energy Technology Data Exchange (ETDEWEB)

    Sellar, C. [Canadian Standards Association Group, Mississauga, ON (Canada); Coles, J. [Ontario Power Generation, Darlington, ON (Canada)

    2014-07-01

    CSA Group has published a new standard on General requirements for nuclear emergency management programs (CSA N1600-14). The standard establishes criteria for the emergency management programs of on- and off-site organizations to address nuclear emergencies at Canadian nuclear power plants (NPPs). It provides the requirements to develop, implement, evaluate, maintain, and continuously improve a nuclear emergency management program for prevention and mitigation, preparedness, response, and recovery from a nuclear emergency at a NPP. This paper discusses the development of the standard, and provides the key drivers, structure, scope, and outline of the standard, while highlighting key features, impacts, and benefits. (author)

  14. Emergency CT in blunt abdominal trauma of multiple injury patients

    International Nuclear Information System (INIS)

    Kinnunen, J.; Kivioja, A.; Poussa, K.; Laasonen, E.M.

    1994-01-01

    Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time. (orig.)

  15. Clinical statistics of patients with dizziness consulting the emergency outpatient clinic

    International Nuclear Information System (INIS)

    Ogawa, Yasuo; Hagiwara, Akira; Kitajima, Naoharu; Inagaki, Taro; Shimizu, Masaaki; Furuse, Hiroko; Konomi, Ujimoto; Yukawa, Kumiko; Suzuki, Mamoru

    2007-01-01

    Between May 2004 and April 2006, 468 emergency patients with vertigo or dizziness consulted the otorhinolarygological emergency room of Tokyo Medical University. Patients with vertigo or dizziness comprised about 9% of the whole otorhinolaryngological emergency patients. The number of female patients was larger than that of male patients. About half of the patients were brought to our hospital by ambulance. Nystagmus was observed in 219 patients (46.8%). Incidence of nystagmus was highest on positional nystagmus test. Brain CT was obtained in 185 patients (39.5%), but there were no abnormal findings in any patients. The most frequent diagnosis was inner ear disorder (22%), followed by Meniere's disease (7%), vestibular neuritis (6%), Benign paroxysmal positional vertigo (BPPV) (6%). Cerebral infarction was observed in 1.9%. Eighty-four patients were admitted. Major diseases requiring admission were vestibular neuritis and inner ear disorder. In patients with cerebral infarction, brain CT was normal. These patients were all elderly males over 60 years old. Their nystagmus in the emergency room did not suggest central disorder, or they did not have other neurological findings. Neurological signs and symptoms appeared thereafter. In the emergency room, establishing a diagnosis by limited examination is difficult. Careful examination is necessary, since vertigo or dizzy patient with a central disorder can show sudden change. (author)

  16. Patient-centered care requires a patient-oriented workflow model.

    Science.gov (United States)

    Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

    2013-06-01

    Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

  17. [Emergency care of vertigo patients: suggestions for efficient management].

    Science.gov (United States)

    Kogashiwa, Yasunao; Takei, Yasuhiko; Matsuda, Takeaki; Karaho, Takehiro; Morita, Masahiro; Kohno, Naoyuki

    2009-10-01

    Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

  18. Matters of concern: a qualitative study of emergency care from the perspective of patients.

    Science.gov (United States)

    Olthuis, Gert; Prins, Carolien; Smits, Marie-Josée; van de Pas, Harm; Bierens, Joost; Baart, Andries

    2014-03-01

    A key to improving the quality of emergency care is improvement of the contact between patient and emergency department (ED) staff. We investigate what patients actually experience during their ED visit to better understand the patterns of relationships among patients and health care professionals. This was an ethnographic study. We conducted observations at the ED of a large general teaching hospital. Patients were enrolled in the study on the basis of convenience sampling. We thoroughly analyzed 16 cases in a grounded theory approach, using the constant comparative methods (ie, starting the analysis with the collection of data). This approach enabled us to conceptualize the experiences of patients step by step, using the ethnographic data to refine and test the theoretical categories that emerged. Our data show that patients at the ED continuously and actively labor to deal with their disorder, its consequences, and the situation they are in. Characteristics of these "patient concerns" indicate a certain trouble, have a personal character, impose themselves with a certain urgency, and require patient effort. We have established a qualitative taxonomy of 5 categories of patient concerns: anxiety, expectations, care provision, endurance, and recognition. Diligence for patient concerns enables ED staff to have a fruitful insight into patients' actual experience. It offers significant clues to improving relationship building in emergency care practice between patients and health care professionals. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  19. 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.

  20. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia

    OpenAIRE

    Mohkamkar, Masoumeh; Farhoudi, Fatemeh; Alam-Sahebpour, Alireza; Mousavi, Seyed-Abdullah; Khani, Soghra; Shahmohammadi, Soheila

    2014-01-01

    Abstract Objective Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. Methods This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-...

  1. Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

    2013-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  2. Emergency service admissions of patients with burn injury

    Directory of Open Access Journals (Sweden)

    Sadiye Yolcu

    2013-09-01

    Full Text Available Objective: In this study, we aimed to investigate the propertiesof burn injured patients who admitted to our hospitalemergency service.Methods: Patients were detected from the hospital recordsof emergency service during six months period andwere divided into five groups according to their ages (60 years. Age, gender totalbody surface area (TBSA, mechanism of injury and theoutcome of emergency evaluation were recorded.Results: Totally 111619 patients admitted to our emergencyservice between 01.07.2011 and 31.12.2011. Duringsix months, 2349 males and 1960 females totally4309 patients were burn injured patients. 1773 patientswere between 0-10 years, 1083 patients were 11-20years, 735 patients were between 21 and 40, 361 patientswere between 41 and 60 and 357 patients were over 60years. Most of the patients were treated in the emergencyservice (90.1%. 0-10% TBSA patients constituted 94.2%.This ratio for burn area >40% was 0.6%. Hot liquid burn(vapored water, milk etc. was 60.2%. There was a significantrelation between mechanism of burn injury andage groups (p<0.05. No corrosive and sunburn injuriesdetermined in females. Age groups were related with hospitalization(p<0.05. The highest intensive care unit admissionwas found in the 0-10 age group (1.3%.Conclusion: Emergency service is the first admission departmentof burn injury patients. Knowing the propertiesof burn injury patients, would help hard-working emergencydoctors in triage of these patients. Also, reportingthe data of emergency service burn injury patients wouldbe helpful for further studies. J Clin Exp Invest 2013; 4(3: 285-288Key words: Burn injury, emergency service, total body surface area

  3. The Profile of Neurology Patients Evaluated in the Emergency Department

    Directory of Open Access Journals (Sweden)

    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

  4. Managing patients with oncologic complications in the emergency department [digest].

    Science.gov (United States)

    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.].

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

    Science.gov (United States)

    Buckler, David L.

    2012-01-01

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

  6. Do we need new personalized emergency telehealth solutions? A survey of 100 emergency department patients and a first report of the swiss limmex emergency wristwatch: an original study.

    Science.gov (United States)

    Tabbara, Malek; Hodel, Thomas; Müller, Urs; Briner, Gabi; Zimmermann, Heinz; Exadaktylos, Aristomenis K

    2012-01-01

    Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces "Limmex" a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.

  7. Do We Need New Personalized Emergency Telehealth Solutions? A Survey of 100 Emergency Department Patients and a First Report of the Swiss Limmex Emergency Wristwatch: An Original Study

    Directory of Open Access Journals (Sweden)

    Malek Tabbara

    2012-01-01

    Full Text Available Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces “Limmex” a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.

  8. Patient satisfaction with physiotherapy in the emergency department.

    Science.gov (United States)

    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.

  9. How do patients with chest pain access Emergency Department care?

    Science.gov (United States)

    Van Severen, Evie; Willemsen, Robert; Vandervoort, Pieter; Sabbe, Marc; Dinant, Geert-Jan; Buntinx, Frank

    2017-12-01

    It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.

  10. Helicopter emergency medical service patient transport safe at night?

    NARCIS (Netherlands)

    Peters, J.H.; Wageningen, B. van; Hoogerwerf, N.; Biert, J.

    2014-01-01

    OBJECTIVE: Dutch helicopter emergency medical services are available 24/7. Working without daylight brings additional challenges, both in patient care and in-flight operation. We retrospectively evaluated the safety of this nighttime helicopter transportation of patients. METHODS: Our helicopter

  11. Preparedness and Response for a Nuclear or Radiological Emergency. General Safety Requirements (Chinese Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This publication, jointly sponsored by the FAO, IAEA, ICAO, ILO, IMO, INTERPOL, OECD/NEA, PAHO, CTBTO, UNEP, OCHA, WHO and WMO, is the new edition establishing the requirements for preparedness and response for a nuclear or radiological emergency which takes into account the latest experience and developments in the area. It supersedes the previous edition of the Safety Requirements for emergency preparedness and response, Safety Standards Series No. GS-R-2, which was published in 2002. This publication establishes the requirements for ensuring an adequate level of preparedness and response for a nuclear or radiological emergency, irrespective of its cause. These Safety Requirements are intended to be used by governments, emergency response organizations, other authorities at the local, regional and national levels, operating organizations and the regulatory body as well as by relevant international organizations at the international level.

  12. Preparedness and Response for a Nuclear or Radiological Emergency. General Safety Requirements (Arabic Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This publication, jointly sponsored by the FAO, IAEA, ICAO, ILO, IMO, INTERPOL, OECD/NEA, PAHO, CTBTO, UNEP, OCHA, WHO and WMO, is the new edition establishing the requirements for preparedness and response for a nuclear or radiological emergency which takes into account the latest experience and developments in the area. It supersedes the previous edition of the Safety Requirements for emergency preparedness and response, Safety Standards Series No. GS-R-2, which was published in 2002. This publication establishes the requirements for ensuring an adequate level of preparedness and response for a nuclear or radiological emergency, irrespective of its cause. These Safety Requirements are intended to be used by governments, emergency response organizations, other authorities at the local, regional and national levels, operating organizations and the regulatory body as well as by relevant international organizations at the international level.

  13. Preparedness and Response for a Nuclear or Radiological Emergency. General Safety Requirements (Russian Edition)

    International Nuclear Information System (INIS)

    2016-01-01

    This publication, jointly sponsored by the FAO, IAEA, ICAO, ILO, IMO, INTERPOL, OECD/NEA, PAHO, CTBTO, UNEP, OCHA, WHO and WMO, is the new edition establishing the requirements for preparedness and response for a nuclear or radiological emergency which takes into account the latest experience and developments in the area. It supersedes the previous edition of the Safety Requirements for emergency preparedness and response, Safety Standards Series No. GS-R-2, which was published in 2002. This publication establishes the requirements for ensuring an adequate level of preparedness and response for a nuclear or radiological emergency, irrespective of its cause. These Safety Requirements are intended to be used by governments, emergency response organizations, other authorities at the local, regional and national levels, operating organizations and the regulatory body as well as by relevant international organizations at the international level.

  14. 33 CFR 157.410 - Emergency lightering requirements for oil tankers.

    Science.gov (United States)

    2010-07-01

    ... HOMELAND SECURITY (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK... Petroleum Oils § 157.410 Emergency lightering requirements for oil tankers. Each oil tanker, to which this...

  15. 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...

  16. Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies.

    Science.gov (United States)

    Henning, Daniel J; Kearney, Kathleen E; Hall, Michael Kennedy; Mahr, Claudius; Shapiro, Nathan I; Nichol, Graham

    2018-02-01

    Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension. This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP)  0.1 ng/mL (37.5, 7.1-198.2), electrocardiographic ischemia (8.9, 4.0-19.8), history of heart failure (2.0, 1.1-3.3), and absence of fever (4.5, 2.3-8.7) (area under the curve [AUC] = 0.83). The prediction score created from these predictors yielded 78% sensitivity and 77% specificity for cardiogenic etiology (AUC = 0.827). Clinical predictors offer reasonable ED screening sensitivity for cardiogenic hypotension, while demonstrating sufficient specificity to facilitate early cardiac interventions.

  17. 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...

  18. Survey of patient awareness and beliefs regarding emergency contraception

    International Nuclear Information System (INIS)

    Amir, F.; Saeed, A.; Fakhar, S.; Saeed, A.A.

    2015-01-01

    Objective: To investigate patient's knowledge and beliefs regarding emergency contraception and its use. Study Design: Cross-sectional descriptive study Place and Duration of Study: A six months cross-sectional descriptive study, from 1st July 2009 till 31st December 2009 carried out at Shifa international Hospital (SIH) and Shifa community health centre (SFCHC) Islamabad. Patients and Methods: All married women of reproductive age coming to SIH or SFCHC clinics after informed consent were interviewed regarding their knowledge of emergency contraception. Results: A total of 770 women were interviewed, but the data was completed for 759 women. 131 women (17.3%) had knowledge about emergency contraception but only 79 (10.4%) had actually used this method for contraception. Conclusion: There is a very low awareness level regarding emergency contraception among women of developing countries even in the urban population. (author)

  19. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for... notification of voluntary relinquishment from Emergency Medicine Patient Safety Foundation of its status as a...

  20. A study on the establishment of habitability requirement for enviromental laboratory in nuclear emergency

    International Nuclear Information System (INIS)

    Khang, Byung Oui

    2003-01-01

    The Establishment of the habitability requirement for Environmental Laboratory (EL) was required to decide the time of movement to a backup EL. The habitability criteria of the EL located inside plum pathway emergency planning zone was established including the alarm setpoint of the area radiation monitor based on the operational intervention level recommended by IAEA. The MDA of analysis equipments were established based on the generic action level recommended by IAEA. The countermeasures for the loss of habitability of EL was established by defined the emergency response activity at EL in nuclear emergency

  1. A study on the impact of prioritising emergency department arrivals on the patient waiting time.

    Science.gov (United States)

    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.

  2. Cancer patients, emergencies service and provision of palliative care

    Directory of Open Access Journals (Sweden)

    Bruno Miranda

    2016-06-01

    Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

  3. Effect of emergency physician burnout on patient waiting times.

    Science.gov (United States)

    De Stefano, Carla; Philippon, Anne-Laure; Krastinova, Evguenia; Hausfater, Pierre; Riou, Bruno; Adnet, Frederic; Freund, Yonathan

    2018-04-01

    Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

  4. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

    Science.gov (United States)

    Bartiaux, M; Mols, P

    2017-01-01

    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  5. 78 FR 51729 - Emergency Clearance: Public Information Collection Requirements Submitted to the Office of...

    Science.gov (United States)

    2013-08-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [Document Identifier: CMS-10496 Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Center for Medicare and Medicaid Services. In compliance with the requirement of section 3506(c)(2)(A) of...

  6. 78 FR 56898 - Emergency Clearance: Public Information Collection Requirements Submitted to the Office of...

    Science.gov (United States)

    2013-09-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [Document Identifier: CMS-10371] Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Center for Medicare and Medicaid Services, HHS. In compliance with the requirement of section 3506(c)(2)...

  7. Diagnosis of Aortic Dissection in Emergency Department Patients is Rare

    Directory of Open Access Journals (Sweden)

    Scott M. Alter

    2015-10-01

    Full Text Available Introduction: Aortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians. Methods: Design: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs. Results: From a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400-13,100] visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8% with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910-1,050] atraumatic chest pain patients. Conclusion: The diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. The CRASH report: emergency management dilemmas facing acute physicians in patients with pulmonary arterial hypertension.

    Science.gov (United States)

    Price, Laura C; Dimopoulos, Konstantinos; Marino, Philip; Alonso-Gonzalez, Rafael; McCabe, Colm; Kemnpy, Aleksander; Swan, Lorna; Boutsikou, Maria; Al Zahrani, Ahmed; Coghlan, Gerry J; Schreiber, Benjamin E; Howard, Luke S; Davies, Rachel; Toshner, Mark; Pepke-Zaba, Joanna; Church, Alistair C; Peacock, Andrew; Corris, Paul A; Lordan, James L; Gaine, Sean; Condliffe, Robin; Kiely, David G; Wort, Stephen John

    2017-11-01

    Treatment of acute emergencies in patients with pulmonary arterial hypertension (PAH) can be challenging. In the UK and Ireland, management of adult patients with PAH is centred in eight nationally designated pulmonary hypertension (PH) centres. However, many patients live far from these centres and physicians in local hospitals are often required to manage PAH emergencies. A committee of physicians from nationally designated PH centres identified the 'most common' emergency clinical scenarios encountered in patients with PAH. Thereafter, a review of the literature was performed centred on these specified topics and a management approach was developed based on best available evidence and expert consensus. Management protocols were developed on the following PAH emergencies: chest pain (including myocardial ischaemia), right ventricular failure, arrhythmias, sepsis, haemoptysis ('CRASH'), as well as considerations relevant to surgery, anaesthesia and pregnancy. Emergencies are not uncommon in PAH. While expertise in PAH management is essential, all physicians involved in acute care should be aware of the principles of acute management of PAH emergencies. A multidisciplinary approach is necessary, with physicians from tertiary PH centres supporting care locally and planning safe transfer of patients to PH centres when appropriate. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Multiple Electrolyte and Metabolic Emergencies in a Single Patient

    Directory of Open Access Journals (Sweden)

    Caprice Cadacio

    2017-01-01

    Full Text Available While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [SNa] 107 mEq/L, hypophosphatemia (“undetectable,” <1.0 mg/dL, and hypokalemia (2.2 mEq/L, moderate diabetic ketoacidosis ([DKA], pH 7.21, serum anion gap [SAG] 37 and hypocalcemia (ionized calcium 4.0 mg/dL, mild hypomagnesemia (1.6 mg/dL, and electrocardiogram with prolonged QTc. Following two liters of normal saline and associated increase in SNa by 4 mEq/L and serum osmolality by 2.4 mosm/Kg, renal service was consulted. We were challenged with minimizing the correction of SNa (or effective serum osmolality to avoid the osmotic demyelinating syndrome while replacing volume, potassium, phosphorus, calcium, and magnesium and concurrently treating DKA. Our management plan was further complicated by an episode of significant aquaresis. A stepwise approach was strategized to prioritize and correct all disturbances with considerations that the treatment of one condition could affect or directly worsen another. The current case demonstrates that a thorough understanding of electrolyte physiology is required in managing complex electrolyte disturbances to avoid disastrous outcomes.

  11. Patients with Borderline Personality Disorder in Emergency Departments

    Science.gov (United States)

    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

  12. [Factors related to patient satisfaction with hospital emergency services].

    Science.gov (United States)

    Parra Hidalgo, Pedro; Bermejo Alegría, Rosa María; Más Castillo, Adelia; Hidalgo Montesinos, María Dolores; Gomis Cebrián, Rafael; Calle Urra, José Eduardo

    2012-01-01

    To determine the perceived quality variables related to satisfaction and to identify the influence of sociodemographic factors on user satisfaction with hospital emergencies. A telephone survey was conducted with a specifically designed questionnaire for use in a sample of 3,600 users of hospital emergency services in nine public hospitals in 2008 and 2009. The adjusted model including all perceived quality and sociodemographic variables explained 47.1% of the variance (adjusted R(2)). Of all the independent variables included, only eight were significant in predicting the level of patient satisfaction. These variables were related to the patient's opinion of the relationship with medical staff (p = 0.041), nurses' and porters' professionalism (p = 0.010 and 0.022), infrastructure (cleanliness and comfort) (p = 0.033 and 0.008), information received at discharge (p = 0.000), waiting time in the emergency department (p = 0.000) and the perception of treatment-diagnosis without failure (p = 0.028). The variables influencing emergency patients' satisfaction were determined, allowing areas where corrective action could be introduced to be identified. In addition, possible confounding factors that should be controlled for when comparing results among distinct hospitals were identified. The emergency satisfaction questionnaire is a useful instrument to evaluate and improve quality of care. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  13. Preparedness and response for a nuclear or radiological emergency. Safety requirements

    International Nuclear Information System (INIS)

    2004-01-01

    This Safety Requirements publication establishes the requirements for an adequate level of preparedness and response for a nuclear or radiological emergency in any State. Their implementation is intended to minimize the consequences for people, property and the environment of any nuclear or radiological emergency. The fulfilment of these requirements will also contribute to the harmonization of arrangements in the event of a transnational emergency. These requirements are intended to be applied by authorities at the national level by means of adopting legislation, establishing regulations and assigning responsibilities. The requirements apply to all those practices and sources that have the potential for causing radiation exposure or environmental radioactive contamination warranting an emergency intervention and that are: (a) Used in a State that chooses to adopt the requirements or that requests any of the sponsoring organizations to provide for the application of the requirements. (B) Used by States with the assistance of the FAO, IAEA, ILO, PAHO, OCHA or WHO in compliance with applicable national rules and regulations. (C) Used by the IAEA or which involve the use of materials, services, equipment, facilities and non-published information made available by the IAEA or at its request or under its control or supervision. Or (d) Used under any bilateral or multilateral arrangement whereby the parties request the IAEA to provide for the application of the requirements. The requirements also apply to the off-site jurisdictions that may need to make an emergency intervention in a State that adopts the requirements. The types of practices and sources covered by these requirements include: fixed and mobile nuclear reactors. Facilities for the mining and processing of radioactive ores. Facilities for fuel reprocessing and other fuel cycle facilities. Facilities for the management of radioactive waste. The transport of radioactive material. Sources of radiation used in

  14. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  15. [An emergency team working closely with the patient].

    Science.gov (United States)

    Selma, Toufik; Chermak, Mustapha; Limani, Mohammed; Rochard, Jacques; Wendlandt, Jérôme; Hernandez, Angélique

    2015-01-01

    ERIC 77 is a rapid response team for emergency psychiatric situations. This cross-sector service based at Marne-la-Vallée general hospital represents a supplementary network in psychiatric patient care. The analysis of the professionals receiving calls as well as the link with the sector are critical in determining the success of patient care. Each risk is measured in order to provide adapted and personalised care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

    Czech Academy of Sciences Publication Activity Database

    Krnačová, V.; Kuběna, Aleš Antonín; Macek, K.; Bezděk, M.; Šmahelová, A.; Vlček, J.

    2012-01-01

    Roč. 156, č. 3 (2012), s. 271-277 ISSN 1213-8118 Grant - others:GA UK(CZ) SVV-2010-261-004 Keywords : regression trees * causes * symptoms * incidence * emergency medical service * severe hypoglycaemia Subject RIV: EI - Biotechnology ; Bionics Impact factor: 0.990, year: 2012 http://library.utia.cas.cz/separaty/2013/E/kubena-severe hypoglycaemia requiring the assistance of emergency medical services - frequency causes and symptoms.pdf

  17. Emergency pulpotomy in relieving acute dental pain among Tanzanian patients

    Directory of Open Access Journals (Sweden)

    Simon Elison NM

    2006-01-01

    Full Text Available Abstract Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9% patients did not experience pain at all while 19 (10.6% experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31% did not experience any pain, 76 (42.2% experienced mild pain and the other 4 (2.2% suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered.

  18. Emergency heart valve replacement: an analysis of 170 patients.

    Science.gov (United States)

    Louw, J W; Kinsley, R H; Dion, R A; Colsen, P R; Girdwood, R W

    1980-05-01

    The results of 170 emergency heart valve procedures performed during a 4 1/2-year period were analyzed. Five pathological groups of patients were recognized: those with infective endocarditis (Group 1, 28 patients); acute rheumatic carditis (Group 2, 43 patients); previous valve operation (Group 3, 29 patients); acute-on-chronic cardiac disease (Group 4, 67 patients); and miscellaneous conditions (Group 5, 3 patients). Mitral, aortic, and multiple valve procedures were performed on 58, 65, and 44 patients, respectively. The most common functional lesion was regurgitation. Hospital mortality was highest in Groups 3 (34%) and 4 (31%). By contrast, among the hospital survivors, the highest rate of attrition was in Group 2. Myocardial failure was the predominat cause of death. In view of the hopeless prognosis without operation, the 52% overall 3-year actuarial survival is a gratifying salvage. Unnecessary procrastination can only jeopardize the prospects for surgical cure.

  19. Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

    2015-07-01

    INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

  20. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Science.gov (United States)

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T

    2014-11-01

    Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  1. Behavioral Emergencies: Special Considerations in the Geriatric Psychiatric Patient.

    Science.gov (United States)

    Aftab, Awais; Shah, Asim A

    2017-09-01

    This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Weather conditions influence the number of psychiatric emergency room patients

    Science.gov (United States)

    Brandl, Eva Janina; Lett, Tristram A.; Bakanidze, George; Heinz, Andreas; Bermpohl, Felix; Schouler-Ocak, Meryam

    2017-12-01

    The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

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

    Directory of Open Access Journals (Sweden)

    Rose L

    2012-03-01

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

  4. Depression and doctor-patient communication in the emergency department.

    Science.gov (United States)

    Haerizadeh, Mytra; Moise, Nathalie; Chang, Bernard P; Edmondson, Donald; Kronish, Ian M

    2016-01-01

    Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS). We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status and comorbidities. Compared to nondepressed patients, depressed patients (PHQ-8≥10) were more likely (Pcommunication on five of seven communication domains: clarity, elicitation of concerns, explanations, patient-centered decision making and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, Pcommunication (adjusted odds ratio 2.42, 95% confidence interval 1.52-3.87; Pcommunication in the ED than nondepressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Ketamine as a first-line treatment for severely agitated emergency department patients.

    Science.gov (United States)

    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.

  6. Patient satisfaction with procedural sedation in the emergency department.

    Science.gov (United States)

    Johnson, Olivia G; Taylor, David McD; Lee, Marina; Ding, Juen-Li; Ashok, Aadith; Johnson, Damian; Peck, Daniel; Knott, Jonathan; Weinberg, Laurence

    2017-06-01

    The aim of this study was to determine patient satisfaction with procedural sedation as a function of nature of the procedure and depth of sedation. We undertook a prospective observational study of adult patients who received procedural sedation in two EDs (20 month period). The level of sedation was determined by an investigator, using the Observers Assessment of Anaesthesia/Sedation Scale (1 = awake to 6 = no response to noxious stimuli). Patient satisfaction was measured with the Iowa Satisfaction with Anaesthesia Scale after full recovery. This was self-administered, comprised 11 items (e.g. 'I felt pain') and has a score range of -3 (poor satisfaction) to +3 (very satisfied). A total of 163 patients were enrolled (51.2% men, mean age 50.7 years). The median (interquartile range) satisfaction score was 2.7 (0.7). Patient satisfaction was lower among patients who had orthopaedic procedures (median 2.6 vs 2.8, P patient satisfaction is high. Greater satisfaction is associated with deeper sedation, sedation with propofol and non-orthopaedic procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  7. Emerging Requirements for Technology Management: A Sector-based Scenario Planning Approach

    Directory of Open Access Journals (Sweden)

    Simon Patrick Philbin

    2013-09-01

    Full Text Available Identifying the emerging requirements for technology management will help organisations to prepare for the future and remain competitive. Indeed technology management as a discipline needs to develop and respond to societal and industrial needs as well as the corresponding technology challenges. Therefore, following a review of technology forecasting methodologies, a sector-based scenario planning approach has been used to derive the emerging requirements for technology management. This structured framework provided an analytical lens to focus on the requirements for managing technology in the healthcare, energy and higher education sectors over the next 5-10 years. These requirements include the need for new business models to support the adoption of technologies; integration of new technologies with existing delivery channels; management of technology options including R&D project management; technology standards, validation and interoperability; and decision-making tools to support technology investment.

  8. Complaints from emergency department patients largely result from treatment and communication problems.

    Science.gov (United States)

    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.

  9. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  10. Prescription History of Emergency Department Patients Prescribed Opioids

    Directory of Open Access Journals (Sweden)

    Jason A Hoppe

    2013-05-01

    Full Text Available Introduction: To use Colorado’s prescription drug monitoring program (PDMP to describe the recent opioid prescription history of patients discharged from our emergency department (ED with a prescription for opioid pain medications.Methods: Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart.Results: There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30% of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296 of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%, cold/flu symptoms (9.5%, back pain (5.4%, flank pain (5.0% and motor vehicle crash (4.7%.Conclusion: Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female. [West J Emerg Med. 2013;14(3:247–252.

  11. 78 FR 77469 - Emergency Clearance: Public Information Collection Requirements Submitted to the Office of...

    Science.gov (United States)

    2013-12-23

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier: CMS-10510] Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Centers for Medicare & Medicaid Services, HHS. In compliance with section 3506(c)(2)(A) of the Paperwork...

  12. 78 FR 62638 - Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management...

    Science.gov (United States)

    2013-10-22

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Agency Recordkeeping/Reporting Requirements Under Emergency Review by the Office of Management and Budget (OMB) Title: Low Income Home Energy Assistance Program (LIHEAP) Grantee Needs Assessment. OMB No.: New Collection. Description: This information collection is a...

  13. Patients overwhelmingly prefer inpatient boarding to emergency department boarding.

    Science.gov (United States)

    Viccellio, Peter; Zito, Joseph A; Sayage, Valerie; Chohan, Jasmine; Garra, Gregory; Santora, Carolyn; Singer, Adam J

    2013-12-01

    Boarding of admitted patients in the emergency department (ED) is a major cause of crowding. One alternative to boarding in the ED, a full-capacity protocol where boarded patients are redeployed to inpatient units, can reduce crowding and improve overall flow. Our aim was to compare patient satisfaction with boarding in the ED vs. inpatient hallways. We performed a structured telephone survey regarding patient experiences and preferences for boarding among admitted ED patients who experienced boarding in the ED hallway and then were subsequently transferred to inpatient hallways. Demographic and clinical characteristics, as well as patient preferences, including items related to patient comfort and safety using a 5-point scale, were recorded and descriptive statistics were used to summarize the data. Of 110 patients contacted, 105 consented to participate. Mean age was 57 ± 16 years and 52% were female. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. The overall preferred location after admission was the inpatient hallway in 85% (95% confidence interval 75-90) of respondents. In comparing ED vs. inpatient hallway boarding, the following percentages of respondents preferred inpatient boarding with regard to the following 8 items: rest, 85%; safety, 83%; confidentiality, 82%; treatment, 78%; comfort, 79%; quiet, 84%; staff availability, 84%; and privacy, 84%. For no item was there a preference for boarding in the ED. Patients overwhelmingly preferred the inpatient hallway rather than the ED hallway when admitted to the hospital. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Emergency staff reactions to suicidal and self-harming patients.

    Science.gov (United States)

    Pompili, Maurizio; Girardi, Paolo; Ruberto, Amedeo; Kotzalidis, Giorgio D; Tatarelli, Roberto

    2005-08-01

    Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.

  15. [Rocuronium and sugammadex in emergency medicine: requirements of a muscle relaxant for rapid sequence induction].

    Science.gov (United States)

    Luxen, J; Trentzsch, H; Urban, B

    2014-04-01

    The required characteristics of neuromuscular blockers for rapid sequence induction (RSI) are clearly defined: nearly immediate effectiveness and short duration of effect. These demands are not only necessary for ideal conditions of quick endotracheal intubation without mask-bag intermediate ventilation but are also essential to enable a quick return to sufficient spontaneous breathing in case of a cannot intubate cannot ventilate situation. Until recently only succinylcholine had these characteristics; however, a considerable number of dangerous side effects and contraindications had to be accepted. In 1996, rocuronium was introduced, which was capable of immediately establishing good intubation conditions similar to succinylcholine. However, the median duration of effect is 45-60 min and it therefore contains a risk if the patient cannot be ventilated and oxygenated. Therefore, rocuronium is considered a good alternative but not a complete substitute for succinylcholine. The introduction of sugammadex in 2008 for quick reversal of rocuronium changed matters. Comparative studies from the past 4 years dealing with rocuronium/sugammadex versus uccinylcholine in RSI showed that rocuronium and sugammadex combined enabled a significantly faster return to sufficient spontaneous ventilation in emergency situations and also proved that the use of rocuronium significantly reduced the degree of desaturation during the interval between injection and ventilation postintubation. rocuronium used in hospital is a very good substitute for succinylcholine as a neuromuscular blocker during RSI as long as sugammadex is at hand for reversal. It remains to be considered that in a situation with severe problems of the airway and breathing, which are the main preclinical indications for intubation, a forward strategy for ventilation of the patient is the only acceptable way in most cases and the return to spontaneous breathing is not an alternative. Therefore, the value of sugammadex

  16. Decision Making Processes for a Pregnant Woman Admitted to the Accident and Emergency Department Requiring Emergency Diagnostic X-ray – A Case Study

    Directory of Open Access Journals (Sweden)

    S. Ismanto

    2017-07-01

    Full Text Available The objective of this study is to apply the decision-making processes for a pregnant woman who was involved in a motor vehicle accident and admitted to a private middle-class hospital in the capital of Indonesia requiring radiologic X-ray examination.  It also aims to examine and evaluate the patient who was in her 20th week of gestation in order to provide her with the best emergency care, diagnostic investigations and treatments.The descriptive, normative and prescriptive models of decision-making are demonstrated. The descriptive model used intuition, while the normative model used decision trees as decision options and lastly the prescriptive decision used the information processing theory (IPT to decide on the best emergency care, diagnostic investigations and treatments for the patient. The IPT dominated the decision-making process; hence an X-ray examination was done that was safe for the fetus and the childbearing mother. Decision option was not used since the patient was in pain and could not understand much of the procedure that was explained.  Intuition helped in the decision-making in order to ensure safe and effective practice.

  17. Lawrence Livermore National Laboratory Emergency Response Capability Baseline Needs Assessment Requirement Document

    Energy Technology Data Exchange (ETDEWEB)

    Sharry, J A

    2009-12-30

    This revision of the LLNL Fire Protection Baseline Needs Assessment (BNA) was prepared by John A. Sharry, LLNL Fire Marshal and LLNL Division Leader for Fire Protection and reviewed by Martin Gresho, Sandia/CA Fire Marshal. The document follows and expands upon the format and contents of the DOE Model Fire Protection Baseline Capabilities Assessment document contained on the DOE Fire Protection Web Site, but only address emergency response. The original LLNL BNA was created on April 23, 1997 as a means of collecting all requirements concerning emergency response capabilities at LLNL (including response to emergencies at Sandia/CA) into one BNA document. The original BNA documented the basis for emergency response, emergency personnel staffing, and emergency response equipment over the years. The BNA has been updated and reissued five times since in 1998, 1999, 2000, 2002, and 2004. A significant format change was performed in the 2004 update of the BNA in that it was 'zero based.' Starting with the requirement documents, the 2004 BNA evaluated the requirements, and determined minimum needs without regard to previous evaluations. This 2010 update maintains the same basic format and requirements as the 2004 BNA. In this 2010 BNA, as in the previous BNA, the document has been intentionally divided into two separate documents - the needs assessment (1) and the compliance assessment (2). The needs assessment will be referred to as the BNA and the compliance assessment will be referred to as the BNA Compliance Assessment. The primary driver for separation is that the needs assessment identifies the detailed applicable regulations (primarily NFPA Standards) for emergency response capabilities based on the hazards present at LLNL and Sandia/CA and the geographical location of the facilities. The needs assessment also identifies areas where the modification of the requirements in the applicable NFPA standards is appropriate, due to the improved fire protection

  18. Triage in an adult emergency service: patient satisfaction

    Directory of Open Access Journals (Sweden)

    Pollyane Liliane Silva

    2016-06-01

    Full Text Available Abstract OBJECTIVE Assess the degree of patient satisfaction with triage in the adult emergency service of a public hospital. METHOD Exploratory, descriptive, cross-sectional study with a quantitative approach. Three hundred patients were interviewed and the data were analyzed using descriptive statistics based on sociodemographic variables and those related to patient satisfaction. RESULTS There was a predominance of women, with elementary education and a mean age of 41 years. Most of the interviewees reported being satisfied in regard to the following items: timely service, embracement, trust, environment (comfort, cleanliness and signage, humanization (courtesy, respect, and interest, timely referral/scheduling of appointments and care expectations. CONCLUSION There was a high level of patient satisfaction, evidenced by the strong association of user satisfaction with the items investigated.

  19. Verification of voltage/ frequency requirement for emergency diesel generator in nuclear power plant using dynamic modeling

    International Nuclear Information System (INIS)

    Hur, J.S.; Roh, M.S.

    2013-01-01

    Full-text: One major cause of the plant shutdown is the loss of electrical power. The study is to comprehend the coping action against station blackout including emergency diesel generator, sequential loading of safety system and to ensure that the emergency diesel generator should meet requirements, especially voltage and frequency criteria using modeling tool. This paper also considered the change of the sequencing time and load capacity only for finding electrical design margin. However, the revision of load list must be verified with safety analysis. From this study, it is discovered that new load calculation is a key factor in EDG localization and in-house capability increase. (author)

  20. Osteomyelitis in burn patients requiring skeletal fixation

    NARCIS (Netherlands)

    Barret, JP; Desai, MH; Herndon, DN

    Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

  1. Impact of interventions for patients refusing emergency medical services transport.

    Science.gov (United States)

    Alicandro, J; Hollander, J E; Henry, M C; Sciammarella, J; Stapleton, E; Gentile, D

    1995-06-01

    To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

  2. Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Ricardo Casalino Sanches de [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Katz, Marcelo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Tarasoutchi, Flávio [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-07-01

    To evaluate the clinical and epidemiological profile of patients with valvular heart disease who arrived decompensated at the emergency department of a university hospital in Brazil. A descriptive analysis of clinical and echocardiographic data of 174 patients with severe valvular disease, who were clinically decompensated and went to the emergency department of a tertiary cardiology hospital, in the State of São Paulo, in 2009. The mean age of participants was 56±17 years and 54% were female. The main cause of valve disease was rheumatic in 60%, followed by 15% of degenerative aortic disease and mitral valve prolapse in 13%. Mitral regurgitation (27.5%) was the most common isolated valve disease, followed by aortic stenosis (23%), aortic regurgitation (13%) and mitral stenosis (11%). In echocardiographic data, the mean left atrial diameter was 48±12mm, 38±12mm for the left ventricular systolic diameter, and 54±12mm for the diastolic diameter; the mean ejection fraction was 56±13%, and the mean pulmonary artery pressure was 53±16mmHg. Approximately half of patients (44%) presented atrial fibrillation, and over one third of them (37%) had already undergone another cardiac surgery. Despite increased comorbidities and age-dependent risk factors commonly described in patients with valvular heart disease, the clinical profile of patients arriving at the emergency department represented a cohort of rheumatic patients in more advanced stages of disease. These patients require priority care in high complexity specialized hospitals.

  3. Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department

    International Nuclear Information System (INIS)

    Moraes, Ricardo Casalino Sanches de; Katz, Marcelo; Tarasoutchi, Flávio

    2014-01-01

    To evaluate the clinical and epidemiological profile of patients with valvular heart disease who arrived decompensated at the emergency department of a university hospital in Brazil. A descriptive analysis of clinical and echocardiographic data of 174 patients with severe valvular disease, who were clinically decompensated and went to the emergency department of a tertiary cardiology hospital, in the State of São Paulo, in 2009. The mean age of participants was 56±17 years and 54% were female. The main cause of valve disease was rheumatic in 60%, followed by 15% of degenerative aortic disease and mitral valve prolapse in 13%. Mitral regurgitation (27.5%) was the most common isolated valve disease, followed by aortic stenosis (23%), aortic regurgitation (13%) and mitral stenosis (11%). In echocardiographic data, the mean left atrial diameter was 48±12mm, 38±12mm for the left ventricular systolic diameter, and 54±12mm for the diastolic diameter; the mean ejection fraction was 56±13%, and the mean pulmonary artery pressure was 53±16mmHg. Approximately half of patients (44%) presented atrial fibrillation, and over one third of them (37%) had already undergone another cardiac surgery. Despite increased comorbidities and age-dependent risk factors commonly described in patients with valvular heart disease, the clinical profile of patients arriving at the emergency department represented a cohort of rheumatic patients in more advanced stages of disease. These patients require priority care in high complexity specialized hospitals

  4. Emergence of respiratory Streptococcus agalactiae isolates in cystic fibrosis patients.

    Directory of Open Access Journals (Sweden)

    Vera Eickel

    Full Text Available Streptococcus agalactiae is a well-known pathogen for neonates and immunocompromized adults. Beyond the neonatal period, S. agalactiae is rarely found in the respiratory tract. During 2002-2008 we noticed S. agalactiae in respiratory secretions of 30/185 (16% of cystic fibrosis (CF patients. The median age of these patients was 3-6 years older than the median age CF patients not harboring S. agalactiae. To analyze, if the S. agalactiae isolates from CF patients were clonal, further characterization of the strains was achieved by capsular serotyping, surface protein determination and multilocus sequence typing (MLST. We found a variety of sequence types (ST among the isolates, which did not substantially differ from the MLST patterns of colonizing strains from Germany. However serotype III, which is often seen in colonizing strains and invasive infections was rare among CF patients. The emergence of S. agalactiae in the respiratory tract of CF patients may represent the adaptation to a novel host environment, supported by the altered surfactant composition in older CF patients.

  5. Patient prioritization in medical emergencies: an ethical analysis.

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Pereira, Patricia Cristina Andrade

    2012-01-01

    To identify and analyze, in the light of ethical considerations, the choices and justifications of public health professionals in hypothetical situations of patient prioritization in circumstances of limited resources during emergency medical care. Qualitative and quantitative study, carried out through interviews with 80 public health professionals, graduate students (MSc and PhD students) in public health who were faced with hypothetical situations involving the criteria of gender, age, and responsibility, asked to choose between alternatives that referred to the existence of people, equally submitted to life-threatening situations, who needed care in an emergency department. The choices prioritized children, young individuals, women, and married women, with decision-making invoking the ethical principles of vulnerability, social utility, and equity. The study shows a clear tendency to justify the choices that were made, guided by utilitarian ethics.

  6. [Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services].

    Science.gov (United States)

    Alcaraz-Martínez, J; Aranaz-Andrés, J M; Martínez-Ros, C; Moreno-Reina, S; Escobar-Álvaro, L; Ortega-Liarte, J V

    2016-01-01

    Evaluate the patient safety incidents that occur in the emergency departments of our region. Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  8. Gastrointestinal surgical emergencies in patients treated for hemathological malignancies.

    Science.gov (United States)

    Caronna, R; Cardi, M; Arcese, W; Iori, A P; Martelli, M; Catinelli, S; Mangioni, S; Corelli, S; Priore, F; Tarantino, E; Frantellizzi, V; Spera, G; Borrini, F; Chirletti, P

    2005-01-01

    Upper and lower gastrointestinal symptoms are major and serious complications in patients who undergo chemotherapy for hematological malignancies. Their most frequent causes are acute intestinal graft-versus-host disease (GVHD) after bone marrow transplant, infections, toxicity or preexisting gastrointestinal diseases. Mortality can reach 30-60% of cases. We report 15 cases operated on for abdominal emergencies: 3 severe gastrointestinal bleeding and 12 acute abdomen. We performed 10 bowel resections, one cholecystectomy, one splenectomy, two laparotomy with pancreatic debridement and peritoneal lavage, and one suture of perforated peptic ulcer. Operative mortality was 33.3% (5/15). Deaths have been reported only in the group of patients with acute abdomen. In all cases death was correlated to generalized sepsis related to immunosuppression. We believe that an aggressive approach, consisting of close monitoring and early laparotomy combined with vigorous supportive therapy, should be used when dealing with suspected gastrointestinal complications in patients with hematological malignancies.

  9. Electrocardiographic findings in Emergency Department patients with pulmonary embolism.

    Science.gov (United States)

    Richman, Peter B; Loutfi, Hassan; Lester, Steven J; Cambell, Patricia; Matthews, Jessica; Friese, Jeremy; Wood, Joseph; Kasper, David; Chen, Frederick; Mandell, Mark

    2004-08-01

    To assess the pre-study, null hypothesis that there is no difference in the electrocardiogram (EKG) findings for Emergency Department (ED) patients who rule in vs. rule out for suspected pulmonary embolism, a retrospective review of a cohort of patients with pulmonary embolism and their controls was conducted in an academic, suburban ED. Patients who were evaluated in the ED during a one-year study period for symptoms suggestive of pulmonary embolism were eligible for inclusion. All patients with pulmonary embolism and sex- and age-matched controls comprised the final study groups. Two board-certified cardiologists reviewed each patient's EKG. There were 350 eligible patients identified; 49 patients with pulmonary embolism and 49 controls were entered into the study. The most common rhythm observed in both groups was normal sinus rhythm (67.3% cases vs. 68.6 % controls; p = 1.0). Abnormalities believed to be associated with pulmonary embolism occurred with similar frequency in both case and control groups (sinus tachycardia [18.8 % vs. 11.8%, respectively; p = 0.40]), incomplete right bundle branch block (4.2% vs. 0.0%, respectively; p = 0.24), complete right bundle branch block (4.2% vs. 6.0, respectively; p = 1.0), S1Q3T3 pattern (2.1 vs. 0.0, respectively; p = 0.49), S1Q3 pattern (0.0 vs. 0.0), and extreme right axis (0.0 vs. 0.0). New EKG changes were identified more frequently for patients with pulmonary embolism (33.3% vs. 12.5% controls; p = 0.03), but specific findings were rarely different between cases and controls. In our cohort of ED patients, we did not identify EKG features that are likely to help distinguish patients with pulmonary embolism from those who rule out for the disease.

  10. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.

    Science.gov (United States)

    Du, Yang; Karvellas, Constantine J; Baracos, Vickie; Williams, David C; Khadaroo, Rachel G

    2014-09-01

    With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. Emerging Good Practices for Transforming Value Assessment: Patients' Voices, Patients' Values.

    Science.gov (United States)

    Perfetto, Eleanor M; Harris, Jason; Mullins, C Daniel; dosReis, Susan

    2018-04-01

    Patient engagement is a transformative strategy for improving value assessment. US value framework developers have increased engagement activities, but more needs to be learned about how to best achieve meaningful patient engagement in value assessment. The objective was to glean good practices in patient engagement emerging from patient community experiences, to be used in value assessment. The National Health Council Value Workgroup conducted a survey and held a focus group with its member advocacy organizations to gather experiences with value framework developers and views on emerging good practices. Ten of 13 organizations completed the survey; reporting 13 interactions with four framework developers. Most rated experiences as "good" to "very good." Emerging good practices included (1) engage early; (2) engage a range of patients; (3) leverage patient-provided information, data resources, and outreach mechanisms; (4) be transparent; and (5) appreciate and accommodate resource constraints. Twelve of 13 organizations participated in the focus group, and this produced 30 emerging good practices in four areas: (1) timing; (2) methodology and data; (3) partnering; and (4) characterizing engagement. Patient engagement was limited in early development of value frameworks but has increased in the past few years. Patient groups report positive experiences that can serve as emerging good practices. These groups also reported experienced challenges in their interactions and recommended good practices to mitigate those challenges. The growing pool of patient engagement experiences can be translated into good practices to advance a patient-centered, value-driven health care ecosystem. Lessons learned from these early experiences can help establish recommend emerging good practices that can eventually result in best practices and standards in the field. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc

  12. What is 5G? Emerging 5G Mobile Services and Network Requirements

    OpenAIRE

    Heejung Yu; Howon Lee; Hongbeom Jeon

    2017-01-01

    In this paper, emerging 5G mobile services are investigated and categorized from the perspective of not service providers, but end-users. The development of 5G mobile services is based on an intensive analysis of the global trends in mobile services. Additionally, several indispensable service requirements, essential for realizing service scenarios presented, are described. To illustrate the changes in societies and in daily life in the 5G era, five megatrends, including the explosion of mobi...

  13. Identification of emergent off-nominal operational requirements during conceptual architecting of the more electric aircraft

    Science.gov (United States)

    Armstrong, Michael James

    Increases in power demands and changes in the design practices of overall equipment manufacturers has led to a new paradigm in vehicle systems definition. The development of unique power systems architectures is of increasing importance to overall platform feasibility and must be pursued early in the aircraft design process. Many vehicle systems architecture trades must be conducted concurrent to platform definition. With an increased complexity introduced during conceptual design, accurate predictions of unit level sizing requirements must be made. Architecture specific emergent requirements must be identified which arise due to the complex integrated effect of unit behaviors. Off-nominal operating scenarios present sizing critical requirements to the aircraft vehicle systems. These requirements are architecture specific and emergent. Standard heuristically defined failure mitigation is sufficient for sizing traditional and evolutionary architectures. However, architecture concepts which vary significantly in terms of structure and composition require that unique failure mitigation strategies be defined for accurate estimations of unit level requirements. Identifying of these off-nominal emergent operational requirements require extensions to traditional safety and reliability tools and the systematic identification of optimal performance degradation strategies. Discrete operational constraints posed by traditional Functional Hazard Assessment (FHA) are replaced by continuous relationships between function loss and operational hazard. These relationships pose the objective function for hazard minimization. Load shedding optimization is performed for all statistically significant failures by varying the allocation of functional capability throughout the vehicle systems architecture. Expressing hazards, and thereby, reliability requirements as continuous relationships with the magnitude and duration of functional failure requires augmentations to the traditional

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

    KAUST Repository

    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.

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

    KAUST Repository

    Harrou, Fouzi

    2015-10-21

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

  16. Complementary and alternative medicine use among paediatric emergency department patients.

    Science.gov (United States)

    Taylor, David McDonald; Dhir, Reetika; Craig, Simon S; Lammers, Thalia; Gardiner, Kaya; Hunter, Kirrily; Joffe, Paul; Krieser, David; Babl, Franz E

    2015-09-01

    To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators. A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM. The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P effective than prescription medicines and safe when taken with prescription medicines. CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  17. Complement activation in emergency department patients with severe sepsis.

    Science.gov (United States)

    Younger, John G; Bracho, David O; Chung-Esaki, Hangyul M; Lee, Moonseok; Rana, Gurpreet K; Sen, Ananda; Jones, Alan E

    2010-04-01

    This study assessed the extent and mechanism of complement activation in community-acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation. A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose-binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients. Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5-fold; Factor Bb 6.1-fold; C3 0.8-fold; C3a 11.6-fold; C5a 1.8-fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty-four hours of structured resuscitation did not, on average, affect any of the mediators studied. Patients with community-acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation.

  18. Compatibility of DOE energy data bases with EEMIS data requirements. [Energy Emergency Management Information Systems

    Energy Technology Data Exchange (ETDEWEB)

    D& #x27; Acierno, J; Hermelee, A

    1979-12-01

    Object of this report is to present the data from EIA data bases which are compatible with the requirements of the data structure for the Energy Emergency Management Information System (EEMIS). An overview of data availability is briefly described and presented in the EEMIS petroleum and natural gas flow diagrams as well as in a more detailed review with each data element in the EEMIS data requirements. This information is presented with the intent that it be used as an overall system guide during the data transfer task as well as in future operation of EEMIS and in the interpretation of EEMIS data.

  19. Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

    Directory of Open Access Journals (Sweden)

    Juarez Neuhaus Barbisan

    Full Text Available CONTEXT: Atrial fibrillation occurs frequently in patients with thyrotoxicosis, while it has low prevalence in adults of the general population. The prevalence of thyroid dysfunction in subjects with atrial fibrillation is 0 to 24%, a wide variation that is attributed to the different methodologies applied. However, continuous use of amiodarone in patients with previous atrial fibrillation may interfere with these prevalence rates. OBJECTIVE: In this study, we present the prevalence of thyroid dysfunction in adult patients who presented at a cardiac emergency room with acute atrial fibrillation, using a sensitive thyroid-stimulating hormone (TSH assay and triiodothyronine (T3 and thyroxine (T4 determination. TYPE OF STUDY: Cross-sectional study SETTING: Emergency room of a tertiary care facility. PARTICIPANTS: A total of 72 patients with atrial fibrillation who presented at the emergency room not more than 48 hours after its onset. PROCEDURES: A standardized questionnaire and 12-lead electrocardiogram were applied, and T3, T4 and TSH were determined. MAIN MEASUREMENTS: TSH, T3 and T4 determination. RESULTS: Among these patients, 16.6% had altered thyroid function tests: 6.9% had hyperthyroidism, 5.6% hypothyroidism and 4.2% had increased T4 levels, by means of amiodarone use. CONCLUSION: The high prevalence of thyroid dysfunction in our study, especially hyperthyroidism, suggests that routine thyroid testing with sensitivethyroid-stimulating hormone assay is required in patients with acute atrial fibrillation.

  20. Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial

    Directory of Open Access Journals (Sweden)

    Cohen, Jason

    2010-02-01

    Full Text Available Objective: Glycemic control in the critically ill intensive care unit (ICU patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED patients in a small pilot trial.Methods: Adult non-trauma, non-pregnant ED patients presenting to a university tertiary referral center and identified as critically ill were eligible for enrollment on a convenience basis. Critical illness was determined upon assignment for ICU admission. Patients were randomized to either ED standard care or glycemic control. Glycemic control involved use of an insulin drip to maintain blood glucose levels between 80-140 mg/dL. Glycemic control continued until ED discharge. Standard patients were managed at ED attending physician discretion. We assessed severity of illness by calculation of APACHE II score. The primary endpoint was in-hospital mortality. Secondary endpoints included vasopressor requirement, hospital length of stay, and mechanical ventilation requirement.Results: Fifty patients were randomized, 24 to the glycemic group and 26 to the standard care cohort. Four of the 24 patients (17% in the treatment arm did not receive insulin despite protocol requirements. While receiving insulin, three of 24 patients (13% had an episode of hypoglycemia. By chance, the patients in the treatment group had a trend toward higher acuity by APACHE II scores. Patient mortality and morbidity were similar despite the acuity difference.Conclusion: There was no difference in morbidity and mortality between the two groups. The benefit of glycemic control may be subject to source of illness and to degree of glycemic control, or have no effect. Such questions bear future investigation. [West J Emerg Med. 2010; 11(1:20-23].

  1. 40 CFR 355.11 - To what substances do the emergency planning requirements of this subpart apply?

    Science.gov (United States)

    2010-07-01

    ... PLANNING AND NOTIFICATION Emergency Planning Who Must Comply § 355.11 To what substances do the emergency... 40 Protection of Environment 27 2010-07-01 2010-07-01 false To what substances do the emergency planning requirements of this subpart apply? 355.11 Section 355.11 Protection of Environment ENVIRONMENTAL...

  2. Management of adrenal emergencies in educated patients with adrenal insufficiency-A prospective study.

    Science.gov (United States)

    Burger-Stritt, Stephanie; Kardonski, Pavel; Pulzer, Alina; Meyer, Gesine; Quinkler, Marcus; Hahner, Stefanie

    2018-07-01

    To evaluate the management of adrenal emergencies (AE) requiring parenteral glucocorticoid (GC) treatment in patients with chronic adrenal insufficiency (AI). Prospective, multicentre, questionnaire-based study. Participating patients (n = 150) with chronic AI were provided with a questionnaire on the management of emergency situations, which had to be completed and sent back in case of an AE. In addition, patients were contacted by phone on a regular basis. Fifty-nine AE in 39 patients were documented. The time interval from contact to arrival of a medical professional was 20 minutes (1-240). In total, in 43 AE, patients received parenteral GC by a medical professional. The time interval between showing the emergency card and GC injection by a medical professional was 60 minutes (5-360). A total of 26 patients administered GC by self-injection. The time from the beginning of symptoms to GC injection was significantly shorter in case of self-injection (self-injection vs injection by medical professional; 85 minutes [20-280] vs 232.5 minutes [1-3135]; P management, most of the patients (84%) indicated a need for an easier way of self-injection. While management of AE by both patients and medical professionals still shows high variability, patients profit from the option of self-injection. Patient care, including education of patients and health-professionals, as well as the way of GC administration, needs further optimization. © 2018 John Wiley & Sons Ltd.

  3. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  4. Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Mehdi Momeni

    2017-12-01

    Full Text Available Introduction: Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective: The aim of this study was to assess the possible impact of emergency department (ED crowding on the quality of care for acute stroke patients. Methods: In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results: The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05. Conclusion: In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.

  5. Helical CT scan for emergent patients with cerebrovascular diseases

    International Nuclear Information System (INIS)

    Matsumoto, Masato; Sato, Naoki; Nakano, Masayuki; Watanabe, Youichi; Kodama, Namio

    1995-01-01

    We studied 44 emergent patients with cerebrovascular diseases (18 cases of subarachnoid hemorrhage, 15 of occlusive lesions, 7 of intracerebral hematoma and 4 of suspected subarachnoid hemorrhage) using helical CT scan. The helical CT scan was performed with contrast medium at a rate of 3 ml/sec with a delay of 20 sec, and was carried out before conventional angiography. The reconstruction time of 3D-CTA was within 10 min. We were able to obtain findings for the lesion on 3D-CTA before those on conventional angiography. The 3D-CTA yielded excellent images of the vascular structures and anatomical relationships of the aneurysm, its neck and parent artery, and surrounding arteries. However, it proved difficult to visualize vessels of less than 1 mm in diameter, especially the perforating arteries. In occlusive diseases, the degree of stenosis depended on the changes in CT number threshold: at present, evaluations of the lesions should be made by conventional angiography. 3D-CTA using helical CT scan can thus be applied for emergent patients with cerebrovascular diseases. Surgical simulation images of 3D-CTA were especially useful at the time of operation. (author)

  6. Helical CT scan for emergent patients with cerebrovascular diseases

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Masato; Sato, Naoki; Nakano, Masayuki; Watanabe, Youichi; Kodama, Namio [Fukushima Medical Coll. (Japan)

    1995-08-01

    We studied 44 emergent patients with cerebrovascular diseases (18 cases of subarachnoid hemorrhage, 15 of occlusive lesions, 7 of intracerebral hematoma and 4 of suspected subarachnoid hemorrhage) using helical CT scan. The helical CT scan was performed with contrast medium at a rate of 3 ml/sec with a delay of 20 sec, and was carried out before conventional angiography. The reconstruction time of 3D-CTA was within 10 min. We were able to obtain findings for the lesion on 3D-CTA before those on conventional angiography. The 3D-CTA yielded excellent images of the vascular structures and anatomical relationships of the aneurysm, its neck and parent artery, and surrounding arteries. However, it proved difficult to visualize vessels of less than 1 mm in diameter, especially the perforating arteries. In occlusive diseases, the degree of stenosis depended on the changes in CT number threshold: at present, evaluations of the lesions should be made by conventional angiography. 3D-CTA using helical CT scan can thus be applied for emergent patients with cerebrovascular diseases. Surgical simulation images of 3D-CTA were especially useful at the time of operation. (author).

  7. Impact of the emergency department streaming decision on patients' outcomes.

    Science.gov (United States)

    Kim, S W; Horwood, C; Li, J Y; Hakendorf, P H; Teubner, D J O; Thompson, C H

    2015-12-01

    Streaming occurs in emergency department (ED) to reduce crowding, but misallocation of patients may impact patients' outcome. The study aims to determine the outcomes of patients misallocated by the ED process of streaming into likely admission or discharge. This is a retrospective cohort study, at an Australian, urban, tertiary referral hospital's ED between January 2010 and March 2012, using propensity score matching for comparison. Total and partitioned ED lengths of stay, inpatient length of stay, in-hospital mortality and 7- and 28-day unplanned readmission rate were compared between patients who were streamed to be admitted against those streamed to be discharged. Total ED length of stay did not differ significantly for admitted patients if allocated to the wrong stream (median 7.6 h, interquartile range 5.7-10.6, cf. 7.5 h, 5.3-11.2; P = 0.34). The median inpatient length of stay was shorter for those initially misallocated to the discharge stream (1.8 days, 1.1-3.0, cf. 2.4 days, 1.4-3.9; P stream stayed in the ED longer than those appropriately allocated (5.2 h, 3.7-7.3, cf. 4.6 h, 3.3-6.4; P streaming process. Patients' discharge from the ED was slower if they had been allocated to the admission stream. Streaming carries few risks for patients misallocated by such a process. © 2015 Royal Australasian College of Physicians.

  8. Transfusion requirements in elective cardiopulmonary bypass surgery patients

    DEFF Research Database (Denmark)

    Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye

    2017-01-01

    Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...

  9. Requirements for radiation emergency urine bioassay techniques for the public and first responders.

    Science.gov (United States)

    Li, Chunsheng; Vlahovich, Slavica; Dai, Xiongxin; Richardson, Richard B; Daka, Joseph N; Kramer, Gary H

    2010-11-01

    Following a radiation emergency, the affected public and the first responders may need to be quickly assessed for internal contamination by the radionuclides involved. Urine bioassay is one of the most commonly used methods for assessing radionuclide intake and radiation dose. This paper attempts to derive the sensitivity requirements (from inhalation exposure) for the urine bioassay techniques for the top 10 high-risk radionuclides that might be used in a terrorist attack. The requirements are based on a proposed reference dose to adults of 0.1 Sv (CED, committed effective dose). In addition, requirements related to sample turnaround time and field deployability of the assay techniques are also discussed. A review of currently available assay techniques summarized in this paper reveals that method development for ²⁴¹Am, ²²⁶Ra, ²³⁸Pu, and ⁹⁰Sr urine bioassay is needed.

  10. Improvement of emergency department patient flow using lean thinking.

    Science.gov (United States)

    Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

    2018-05-01

    To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

  11. Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

    Science.gov (United States)

    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…

  12. Forecasting daily patient volumes in the emergency department.

    Science.gov (United States)

    Jones, Spencer S; Thomas, Alun; Evans, R Scott; Welch, Shari J; Haug, Peter J; Snow, Gregory L

    2008-02-01

    Shifts in the supply of and demand for emergency department (ED) resources make the efficient allocation of ED resources increasingly important. Forecasting is a vital activity that guides decision-making in many areas of economic, industrial, and scientific planning, but has gained little traction in the health care industry. There are few studies that explore the use of forecasting methods to predict patient volumes in the ED. The goals of this study are to explore and evaluate the use of several statistical forecasting methods to predict daily ED patient volumes at three diverse hospital EDs and to compare the accuracy of these methods to the accuracy of a previously proposed forecasting method. Daily patient arrivals at three hospital EDs were collected for the period January 1, 2005, through March 31, 2007. The authors evaluated the use of seasonal autoregressive integrated moving average, time series regression, exponential smoothing, and artificial neural network models to forecast daily patient volumes at each facility. Forecasts were made for horizons ranging from 1 to 30 days in advance. The forecast accuracy achieved by the various forecasting methods was compared to the forecast accuracy achieved when using a benchmark forecasting method already available in the emergency medicine literature. All time series methods considered in this analysis provided improved in-sample model goodness of fit. However, post-sample analysis revealed that time series regression models that augment linear regression models by accounting for serial autocorrelation offered only small improvements in terms of post-sample forecast accuracy, relative to multiple linear regression models, while seasonal autoregressive integrated moving average, exponential smoothing, and artificial neural network forecasting models did not provide consistently accurate forecasts of daily ED volumes. This study confirms the widely held belief that daily demand for ED services is characterized by

  13. Undertriage in older emergency department patients--tilting against windmills?

    Directory of Open Access Journals (Sweden)

    Florian F Grossmann

    Full Text Available The aim of this study was to investigate the long-term effect of a teaching intervention designed to reduce undertriage rates in older ED patients. Further, to test the hypothesis that non-adherence to the Emergency Severity Index (ESI triage algorithm is associated with undertriage. Additionally, to detect patient related risk factors for undertriage.Pre-post-test design. The study sample consisted of all patients aged 65 years or older presenting to the ED of an urban tertiary and primary care center in the study periods. A teaching intervention designed to increase adherence to the triage algorithm. To assess, if the intervention resulted in an increase of factual knowledge, nurses took a test before and immediately after the teaching intervention. Undertriage rates were assessed one year after the intervention and compared to the pre-test period.In the pre-test group 519 patients were included, and 394 in the post-test-group. Factual knowledge among triage nurses was high already before the teaching intervention. Prevalence of undertriaged patients before (22.5% and one year after the intervention (24.2% was not significantly different (χ2 = 0.248, df = 1, p = 0.619. Sex, age, mode of arrival, and type of complaint were not identified as independent risk factors for undertriage. However, undertriage rates increased with advancing age. Adherence to the ESI algorithm is associated with correct triage decisions.Undertriage of older ED patients remained unchanged over time. Reasons for undertriage seem to be more complex than anticipated. Therefore, additional contributing factors should be addressed.

  14. Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

    Directory of Open Access Journals (Sweden)

    Keith Boniface

    2011-05-01

    Full Text Available Introduction: To assess characteristics, satisfaction, and disposition of emergency department (ED patients who successfully received ultrasound (US-guided peripheral intravenous (IV access. Methods: This is a prospective observational study among ED patients who successfully received US-guided peripheral IV access by ED technicians. Nineteen ED technicians were taught to use US guidance to obtain IV access. Training sessions consisted of didactic instruction and hands-on practice. The US guidance for IV access was limited to patients with difficult access. After successfully receiving an US-guided peripheral IV, patients were approached by research assistants who administered a 10-question survey. Disposition information was collected after the conclusion of the ED visit by accessing patients’ electronic medical record. Results: In total, 146 surveys were completed in patients successfully receiving US-guided IVs. Patients reported an average satisfaction with the procedure of 9.2 of 10. Forty-two percent of patients had a body mass index (BMI of greater than 30, and 17.8% had a BMI of more than 35. Sixty-two percent reported a history of central venous catheter placement. This patient population averaged 3 ED visits per year in the past year. Fifty-three percent of the patients were admitted. Conclusion: Patients requiring US-guided IVs in our ED are discharged home at the conclusion of their ED visit about half of the time. These patients reported high rates of both difficult IV access and central venous catheter placement in the past. Patient satisfaction with US-guided IVs was very high. These data support the continued use of US-guided peripheral IVs in this patient population. [West J Emerg Med. 2011;12(4:475–477.

  15. 3D GEO-INFORMATION REQUIREMENTS FOR DISASTER AND EMERGENCY MANAGEMENT

    Directory of Open Access Journals (Sweden)

    E. Demir Ozbek

    2016-06-01

    Full Text Available A conceptual approach is proposed to define 3D geo-information requirement for different types of disasters. This approach includes components such as Disaster Type-Sector-Actor-Process-Activity-Task-Data. According to disaster types processes, activities, tasks, sectors, and responsible and operational actors are derived. Based on the tasks, the needed level of detail for 3D geo-information model is determined. The levels of detail are compliant with the 3D international standard CityGML. After a brief introduction on the disaster phases and geo-information requirement for actors to perform the tasks, the paper discusses the current situation of disaster and emergency management in Turkey and elaborates on components of conceptual approach. This paper discusses the 3D geo-information requirements for the tasks to be used in the framework of 3D geo-information model for Disaster and Emergency Management System in Turkey. The framework is demonstrated for an industrial fire case in Turkey.

  16. What is a health emergency? The difference in definition and understanding between patients and health professionals.

    Science.gov (United States)

    Morgans, Amee; Burgess, Stephen J

    2011-08-01

    Investigations into 'inappropriate' use of emergency health services are limited by the lack of definition of what constitutes a health emergency. Position papers from Australian and international sources emphasise the patient's right to access emergency healthcare, and the responsibility of emergency health care workers to provide treatment to all patients. However, discordance between the two perspectives remain, with literature labelling patient use of emergency health services as 'inappropriate'. To define a 'health emergency' and compare patient and health professionals perspectives. A sample of 600 emergency department (ED) patients were surveyed about a recent health experience and asked to rate their perceived urgency. This rating was compared to their triage score allocated at the hospital ED. No significant relationship was found between the two ratings of urgency (P=0.51). CONCLUSIONS; Differing definitions of a 'health emergency' may explain patient help-seeking behaviour when accessing emergency health resources including hospital ED and ambulance services. A new definition of health emergency that encapsulates the health professional and patient perspectives is proposed. An agreed definition of when emergency health resources should be used has the potential to improve emergency health services demand and patient flow issues, and optimise emergency health resource allocation.

  17. [Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients].

    Science.gov (United States)

    Passamar, M; Tellier, O; Vilamot, B

    2011-12-01

    Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. The time spent on the initial meeting and assessment is essential. The evolution of professional practices in mental health allows us to distinguish three kinds of sedation (vigilance, behaviour and psychical) that guide the choice and the mode of psychotropic drug use. The harmful effects of an ever-increasing use of sedation is debated. The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment. Copyright © 2011. Published by Elsevier Masson SAS.

  18. Development and testing of emergency department patient transfer communication measures.

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    Communication problems are a major contributing factor to adverse events in hospitals.(1) The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013. © 2011 National Rural Health Association.

  19. Emergency department patients with small bowel obstruction: What is the anticipated clinical course?

    Institute of Scientific and Technical Information of China (English)

    Sarah E Frasure; Amy Hildreth; Sukhjit Takhar; Michael B Stone

    2016-01-01

    BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.

  20. Users’ Participation in Requirements Gathering for Smart Phones Applications in Emerging Markets

    DEFF Research Database (Denmark)

    Aryana, Bijan; Clemmensen, Torkil; Boks, Casper

    2015-01-01

    This study presents insights from using requirements gathering techniques for country-specific customization of smart phones in two emerging markets, Iran and Turkey. In each country, a group of users participated in requirements gathering sessions that were aimed at developing design ideas...... for overcoming country-specific usability problems. Using qualitative content analysis, it was found that in each country some specific interaction activities were considered more when participants generated design ideas for country-specific usability problems. It was also found that even for similar usability...... problems, participants suggested country-specific solutions. Therefore, it is suggested that participation of local users in the design process should not be limited to identification of usability problems, but should also include the problem-solving phase that is usually a phase in design and development...

  1. Facilitators and barriers in pain management for trauma patients in the chain of emergency care.

    Science.gov (United States)

    Berben, Sivera A A; Meijs, Tineke H J M; van Grunsven, Pierre M; Schoonhoven, Lisette; van Achterberg, Theo

    2012-09-01

    The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA. This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs. Identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift

  2. [Palliative care and end-of-life patients in emergency situations. Recommendations on optimization of out-patient care].

    Science.gov (United States)

    Wiese, C H R; Vagts, D A; Kampa, U; Pfeiffer, G; Grom, I-U; Gerth, M A; Graf, B M; Zausig, Y A

    2011-02-01

    At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients. For data collection an open discussion of the main topics by experts in palliative and emergency medical care was employed. Main outcome measures and recommendations included responses regarding current practices related to expert opinions and international literature sources. As the essential points of consensus the following recommendations for optimization of care were named: (1) integration of palliative care in the emergency medicine curricula for pre-hospital emergency physicians and paramedics, (2) development of outpatient palliative care, (3) integration of palliative care teams into emergency medical structures, (4) cooperation between palliative and emergency medical care, (5) integration of crisis intervention into outpatient palliative emergency medical care, (6) provision of emergency plans and emergency medical boxes, (7) provision of palliative crisis cards and do not attempt resuscitation (DNAR) orders, (8) psychosocial aspects concerning palliative emergencies and (9) definition of palliative patients and their special situation by the physician responsible for prior treatment. Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive

  3. Overlapping Requirements for Tet2 and Tet3 in Normal Development and Hematopoietic Stem Cell Emergence

    Directory of Open Access Journals (Sweden)

    Cheng Li

    2015-08-01

    Full Text Available The Tet family of methylcytosine dioxygenases (Tet1, Tet2, and Tet3 convert 5-methylcytosine to 5-hydroxymethylcytosine. To date, functional overlap among Tet family members has not been examined systematically in the context of embryonic development. To clarify the potential for overlap among Tet enzymes during development, we mutated the zebrafish orthologs of Tet1, Tet2, and Tet3 and examined single-, double-, and triple-mutant genotypes. Here, we identify Tet2 and Tet3 as the major 5-methylcytosine dioxygenases in the zebrafish embryo and uncover a combined requirement for Tet2 and Tet3 in hematopoietic stem cell (HSC emergence. We demonstrate that Notch signaling in the hemogenic endothelium is regulated by Tet2/3 prior to HSC emergence and show that restoring expression of the downstream gata2b/scl/runx1 transcriptional network can rescue HSCs in tet2/3 double mutant larvae. Our results reveal essential, overlapping functions for tet genes during embryonic development and uncover a requirement for 5hmC in regulating HSC production.

  4. Employment of telemedicine in emergency medicine. Clinical requirement analysis, system development and first test results.

    Science.gov (United States)

    Czaplik, M; Bergrath, S; Rossaint, R; Thelen, S; Brodziak, T; Valentin, B; Hirsch, F; Beckers, S K; Brokmann, J C

    2014-01-01

    Demographic change, rising co-morbidity and an increasing number of emergencies are the main challenges that emergency medical services (EMS) in several countries worldwide are facing. In order to improve quality in EMS, highly trained personnel and well-equipped ambulances are essential. However several studies have shown a deficiency in qualified EMS physicians. Telemedicine emerges as a complementary system in EMS that may provide expertise and improve quality of medical treatment on the scene. Hence our aim is to develop and test a specific teleconsultation system. During the development process several use cases were defined and technically specified by medical experts and engineers in the areas of: system administration, start-up of EMS assistance systems, audio communication, data transfer, routine tele-EMS physician activities and research capabilities. Upon completion, technical field tests were performed under realistic conditions to test system properties such as robustness, feasibility and usability, providing end-to-end measurements. Six ambulances were equipped with telemedical facilities based on the results of the requirement analysis and 55 scenarios were tested under realistic conditions in one month. The results indicate that the developed system performed well in terms of usability and robustness. The major challenges were, as expected, mobile communication and data network availability. Third generation networks were only available in 76.4% of the cases. Although 3G (third generation), such as Universal Mobile Telecommunications System (UMTS), provides beneficial conditions for higher bandwidth, system performance for most features was also acceptable under adequate 2G (second generation) test conditions. An innovative concept for the use of telemedicine for medical consultations in EMS was developed. Organisational and technical aspects were considered and practical requirements specified. Since technical feasibility was demonstrated in these

  5. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients

    Directory of Open Access Journals (Sweden)

    Roland N. Dickerson

    2016-04-01

    Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.

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

    Science.gov (United States)

    Madsen, Thomas Lill; Kofoed-Enevoldsen, Allan

    2011-10-01

    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 in order to document its relevance. We compared actual versus theoretical distributions of hourly patient flow from 27,000 patient cases seen at Frederiksberg Hospital's ED. Formulating equations for arrivals and capacity, we wrote and tested a five equation simulation model. The Poisson distribution fitted arrivals with an hour-of-the-day specific parameter. Treatment times exceeding 15 minutes were well-described by an exponential distribution. The ED can be modelled as a black box with an hourly capacity that can be estimated either as admissions per hour when the ED operates full hilt Poisson distribution or from the linear dependency of waiting times on queue number. The results show that our ED capacity is surprisingly constant despite variations in staffing. These findings led to the formulation of a model giving a compact framework for assessing the behaviour of the ED under different assumptions about opening hours, capacity and workload. The M/M/1 almost perfectly fits our. Thus modeling and simulations have contributed to the management process. not relevant. not relevant.

  7. Characteristics and Outcomes of Patients Injured in Road Traffic Crashes and Transported by Emergency Medical Services

    Directory of Open Access Journals (Sweden)

    Chun-Ying Huang

    2016-02-01

    Full Text Available To investigate the injury characteristics and mortality of patients transported by emergency medical services (EMS and hospitalized for trauma following a road traffic crash, data obtained from the Trauma Registry System were retrospectively reviewed for trauma admissions between 1 January 2009 and 31 December 2013 in a Level I trauma center. Of 16,548 registered patients, 3978 and 1440 patients injured in road traffic crashes were transported to the emergency department by EMS and non-EMS, respectively. Patients transported by EMS had lower Glasgow coma scale (GCS scores and worse hemodynamic measures. Compared to patients transported by non-EMS, more patients transported by EMS required procedures (intubation, chest tube insertion, and blood transfusion at the emergency department. They also sustained a higher injury severity, as measured by the injury severity score (ISS and the new injury severity score (NISS. Lastly, in-hospital mortality was higher among the EMS than the non-EMS group (1.8% vs. 0.3%, respectively; p < 0.001. However, we found no statistically significant difference in the adjusted odds ratio (AOR for mortality among patients transported by EMS after adjustment for ISS (AOR 4.9, 95% CI 0.33–2.26, indicating that the higher incidence of mortality was likely attributed to the patients’ higher injury severity. In addition, after propensity score matching, logistic regression of 58 well-matched pairs did not show a significant influence of transportation by EMS on mortality (OR: 0.578, 95% CI: 0.132–2.541 p = 0.468.

  8. Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose.

    Science.gov (United States)

    Scheuermeyer, Frank X; DeWitt, Christopher; Christenson, Jim; Grunau, Brian; Kestler, Andrew; Grafstein, Eric; Buxton, Jane; Barbic, David; Milanovic, Stefan; Torkjari, Reza; Sahota, Indy; Innes, Grant

    2018-03-09

    Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose. At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality. Primary outcome was a composite of admission and death within 24 hours. Other outcomes included treatment with additional ED naloxone, development of a new medical issue while in the ED, and length of stay. A prespecified subgroup analysis assessed low-risk patients with normal triage vital signs. There were 1,009 uncomplicated presumed fentanyl overdose, mainly by injection. Median age was 34 years, 85% were men, and 82% received out-of-hospital naloxone. One patient was hospitalized and one discharged patient died within 24 hours (combined outcome 0.2%; 95% confidence interval [CI] 0.04% to 0.8%). Sixteen patients received additional ED naloxone (1.6%; 95% CI 1.0% to 2.6%), none developed a new medical issue (0%; 95% CI 0% to 0.5%), and median length of stay was 173 minutes (interquartile range 101 to 267). For 752 low-risk patients, no patients were admitted or developed a new issue, and one died postdischarge; 3 (0.4%; 95% CI 0.01% to 1.3%) received ED naloxone. In our cohort of ED patients with uncomplicated presumed fentanyl overdose-typically after injection-deterioration, admission, mortality, and postdischarge complications appear low; the majority can be discharged after brief observation. Patients with normal triage vital signs are unlikely to require ED naloxone. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. Value of abdominal CT in the emergency department for patients with abdominal pain

    International Nuclear Information System (INIS)

    Rosen, Max P.; Siewert, Bettina; Bromberg, Rebecca; Raptopoulos, Vassilios; Sands, Daniel Z.; Edlow, Jonathan

    2003-01-01

    The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for patients with non-traumatic abdominal pain. Between August 1998 and April 1999, 536 consecutive patients with non-traumatic abdominal pain were entered into our study. Using a computer order entry system, physicians were asked to identify: (a) their most likely diagnosis; (b) their level of certainty in their diagnosis; (c) if they thought CT would be normal or abnormal; (d) their treatment plan (prior to knowledge of the CT results); and (e) their role in deciding to order CT. This information was correlated with each patient's post-CT diagnosis and subsequent management. Pre- and post-CT diagnoses were concordant in 200 of 536 (37%) patients. The physicians' certainty in the accuracy of their pre-CT diagnosis was less than high in 88% of patients. Prior to CT, the management plan included hospital admission for 402 patients. Following CT, only 312 patients were actually admitted; thus, the net impact of performing CT was to obviate the need for hospital admission in 90 of 536 (17%) of patients with abdominal pain. Prior to CT, 67 of 536 (13%) of all patients would have undergone immediate surgery; however, following CT only 25 (5%) actually required immediate surgery. Among patients with the four most common pre-CT diagnoses (appendicitis, abscess, diverticulitis, and urinary tract stones) CT had the greatest impact on hospital admission and surgical management for patients with suspected appendicitis. For patients with suspected appendicitis, CT reduced the hospital admission rate in 28% (26 of 91) of patients and changed the surgical management in 40% (39 of 91) of patients. Our study demonstrates the advantage of performing abdominal CT in the ED for patients with non-traumatic abdominal pain. (orig.)

  10. Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments.

    Science.gov (United States)

    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

  11. How Can an Emergency Department Assist Patients and Caregivers at the End of Life?

    Science.gov (United States)

    ... 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 ...

  12. Incident Reporting to Improve Patient Safety: The Effects of Process Variance on Pediatric Patient Safety in the Emergency Department.

    Science.gov (United States)

    OʼConnell, Karen J; Shaw, Kathy N; Ruddy, Richard M; Mahajan, Prashant V; Lichenstein, Richard; Olsen, Cody S; Funai, Tomohiko; Blumberg, Stephen; Chamberlain, James M

    2018-04-01

    Medical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine patient care. We performed a planned subanalysis of the Pediatric Emergency Care Applied Research Network incident reporting data classified as process variance events. Confidential deidentified incident reports (IRs) were collected and classified by 2 independent investigators. Events categorized as process variance were then subtyped for severity and contributing factors. Data were analyzed using descriptive statistics. The study intention was to describe and measure reported medical errors related to process variance in 17 EDs in the Pediatric Emergency Care Applied Research Network from 2007 to 2008. Between July 2007 and June 2008, 2906 eligible reports were reviewed. Process variance events were identified in 15.4% (447/2906). The majority were related to patient flow (35.4%), handoff communication (17.2%), and patient identification errors (15.9%). Most staff involved included nurses (47.9%) and physicians (28%); trainees were infrequently reported. The majority of events did not result in harm (65.7%); 17.9% (80/447) of cases were classified as unsafe conditions but did not reach the patient. Temporary harm requiring further treatment or hospitalization was reported in 5.6% (25/447). No events resulted in permanent harm, near death, or death. Contributing factors included human factors (92.1%), in particular handoff communication, interpersonal skills, and compliance with established procedures, and system-level errors (18.1%), including unclear or unavailable policies and inadequate staffing levels. Although process variance events accounted for approximately 1 in 6 reported safety events, very few led to patient harm. Because human and system-level factors contributed to

  13. Trends in boarding of admitted patients in US Emergency Departments 2003-2005.

    Science.gov (United States)

    Carr, Brendan G; Hollander, Judd E; Baxt, William G; Datner, Elizabeth M; Pines, Jesse M

    2010-10-01

    Boarding of admitted patients in the Emergency Department (ED) is common and is associated with poor patient outcomes. We sought to estimate the magnitude of and trends for ED boarding in the US. We used the 2003-2005 National Hospital Ambulatory Medical Care Survey to estimate the time patients spent boarding in EDs in the US. We used fixed and imputed times required to evaluate, treat, and decide to admit each patient using the number of medications and diagnostic tests received. We calculated the absolute and relative patient-care hours spent boarding in US EDs over the 3-year period. Total patient-hours spent in US EDs increased from 209 million to 217 million between 2003 and 2005. Overall admission rates decreased between 2003 and 2005 (13.9% in 2003, 12.3% in 2005), whereas intensive care unit admission rates increased (1.3% in 2003, 2.0% in 2005). Mean ED length of stay decreased (5.4 h in 2003, 4.6 h in 2005). The proportion of patient-hours accounted for by ED boarding decreased over the study period (11.3-17.1% in 2003, 5.9-15.3% in 2004, and 2.8-12.0% 2005). Boarding of admitted patients in the ED accounts for a substantial portion of ED patient-care hours. Overall boarding time decreased over the 3 years. Copyright © 2010 Elsevier Inc. All rights reserved.

  14. [Budget impact analysis of idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations in Italy

    Directory of Open Access Journals (Sweden)

    Andrea Belisari

    2016-06-01

    CONCLUSION: Idarucizumab for the management of patients treated with dabigatran in emergency / urgent situations has the potential for substantial savings, compared to treatments currently available. This preliminary assessment will require further confirmatory evidence when the product will become available in Italian healthcare setting. [Article in Italian

  15. The determination of nutritional requirements for Safe Haven Food Supply System (emergency/survival foods)

    Science.gov (United States)

    Ahmed, Selina

    1987-01-01

    The Space Station Safe Haven Food System must sustain 8 crew members under emergency conditions for 45 days. Emergency Survival Foods are defined as a nutritionally balanced collection of high density food and beverages selected to provide for the survival of Space Station flight crews in contingency situations. Since storage volume is limited, the foods should be highly concentrated. A careful study of different research findings regarding starvation and calorie restricted diets indicates that a minimum nutritional need close to RDA is an important factor for sustaining an individual's life in a stressful environment. Fat, protein, and carbohydrates are 3 energy producing nutrients which play a vital role in the growth and maintenance process of human life. A lower intake of protein can minimize the water intake, but it causes a negative nitrogen balance and a lower performance level. Other macro and micro nutrients are also required for nutritional interrelationships to metabolize the other 3 nutrients to their optimum level. The various options for longer duration than 45 days are under investigation.

  16. Converging requirements and emerging challenges to public health diseases surveillance and bio surveillance

    International Nuclear Information System (INIS)

    Rao, V.; Abel, T.

    2009-01-01

    Disease surveillance systems are a critical component of an early warning system for public health agencies to prepare and respond to major public health catastrophes. With a growing emphasis for more robust early indicator and warning systems to track emerging and dangerous diseases of suspicious nature, considerable emphasis is now placed on deployment of more expanded electronic disease surveillance systems. The architectural considerations for bio surveillance information system are based on collection, analysis and dissemination of human, veterinary and agricultural related disease surveillance to broader regional areas likely to be affected in the event of an emerging disease, or due to bioterrorism and better coordinate plans, preparations and response by governmental agencies and multilateral forums. The diseases surveillance systems architectures by intent and design could as well support biological threat monitoring and threat reduction initiatives. As an illustrative sample set, this paper will describe the comparative informatics requirements for a disease surveillance systems developed by CSC for the US Centers for Diseases Control and Prevention (CDC) currently operational nationwide, and biological weapons threat assessment developed as part of the Threat Agent Detection and Response (TADR) Network under the US Biological Threat Reduction Program and deployed at Uzbekistan, Kazakhstan, Georgia, and Azerbaijan.(author)

  17. Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences.

    Science.gov (United States)

    Montgomery, Phyllis; Godfrey, Michelle; Mossey, Sharolyn; Conlon, Michael; Bailey, Patricia

    2014-04-01

    Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. The majority of the 122 critically ill patients boarded in the ED were male, 55 years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34 min, with a range of 0-1549 min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Oil spill emergency response: Fulfilling regulatory requirements on the Grand Banks

    International Nuclear Information System (INIS)

    Horvath, C.L.

    1991-01-01

    Offshore well licensing under Canadian regulations requires the operator to conduct a practice exercise of oil spill countermeasures and emergency response procedures at least yearly, once the drilling program starts. The relevant parts of the Newfoundland Offshore Petroleum Drilling Regulations are summarized and the objectives and benefits of the practice exercises are reviewed. In addition to ensuring regulatory compliance, the exercises also provide the opportunity to test operational procedures, to provide in-house training, and improve response efficiency by regular repetition of the exercise. Exercises in communications during a spill incident in the offshore and in deployment of offshore spill response equipment conducted by Petro-Canada in Newfoundland are described. Problems identified during the exercises are noted

  19. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

    Directory of Open Access Journals (Sweden)

    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  20. Matters of concern: a qualitative study of emergency care from the perspective of patients

    NARCIS (Netherlands)

    Olthuis, G.J.; Prins, C.; Smits, M.J.A.; Pas, H. van de; Bierens, J.J.; Baart, A.

    2014-01-01

    STUDY OBJECTIVE: A key to improving the quality of emergency care is improvement of the contact between patient and emergency department (ED) staff. We investigate what patients actually experience during their ED visit to better understand the patterns of relationships among patients and health

  1. Differences in emergency colorectal surgery in Medicaid and uninsured patients by hospital safety net status.

    Science.gov (United States)

    Bradley, Cathy J; Dahman, Bassam; Sabik, Lindsay M

    2015-02-01

    We examined whether safety net hospitals reduce the likelihood of emergency colorectal cancer (CRC) surgery in uninsured and Medicaid-insured patients. If these patients have better access to care through safety net providers, they should be less likely to undergo emergency resection relative to similar patients at non- safety net hospitals. Using population-based data, we estimated the relationship between safety net hospitals, patient insurance status, and emergency CRC surgery. We extracted inpatient admission data from the Virginia Health Information discharge database and matched them to the Virginia Cancer Registry for patients aged 21 to 64 years who underwent a CRC resection between January 1, 1999, and December 31, 2005 (n = 5488). We differentiated between medically defined emergencies and those that originated in the emergency department (ED). For each definition of emergency surgery, we estimated the linear probability models of the effects of being treated at a safety net hospital on the probability of having an emergency resection. Safety net hospitals reduce emergency surgeries among uninsured and Medicaid CRC patients. When defining an emergency resection as those that involved an ED visit, these patients were 15 to 20 percentage points less likely to have an emergency resection when treated in a safety net hospital. Our results suggest that these hospitals provide a benefit, most likely through the access they afford to timely and appropriate care, to uninsured and Medicaid-insured patients relative to hospitals without a safety net mission.

  2. Emergency Contraception: Do Your Patients Have a Plan B?

    Science.gov (United States)

    Bullock, Holly; Salcedo, Jennifer

    2015-12-01

    Emergency contraception is used after unprotected sex, inadequately protected sex, or sexual assault to reduce the risk of pregnancy. Of emergency contraceptive methods available in the United States, the copper intrauterine device has the highest efficacy, followed by ulipristal acetate, levonorgestrel-containing emergency contraceptive pills, and the Yuzpe method. However, access to the most effective methods is limited. Although advanced prescription of emergency contraceptive pills and counseling on emergency contraception to all reproductive-aged women is recommended, women should be advised to contact their health care providers after taking emergency contraceptive pills to discuss possible copper intrauterine device placement and other follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Web-based multimedia courseware for emergency cardiac patient management simulations.

    Science.gov (United States)

    Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

    2000-01-01

    This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements.

  4. Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patients.

    Science.gov (United States)

    Yeaman, Fiona; Meek, Robert; Egerton-Warburton, Diana; Rosengarten, Pamela; Graudins, Andis

    2014-06-01

    There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. This is a prospective, observational study of adult ED patients presenting with severe pain (≥6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (≥20 mm) at 30 min; dose resulting in clinically significant pain reduction. Of the 72 patients available for analysis, median age was 34.5 years and 64% were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56%, 95% CI: 44.0-66.7) reported VAS reduction ≥20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    Directory of Open Access Journals (Sweden)

    Chang CH

    2015-04-01

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

  6. 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.

  7. [Hospital-based acute care of emergency patients: the importance of interdisciplinary teamwork].

    Science.gov (United States)

    Gräff, I; Lenkeit, S

    2014-10-01

    The care of emergency patients with life-threatening injuries or diseases presents a special challenge to the treatment team. Good interdisciplinary cooperation is essential for fast, priority-oriented, and efficient emergency room management. Particularly in complex situations, such as trauma room care, so-called human factors largely determine the safety and performance of the individual as well as the team. Approximately 70 % of all adverse events stem from human factors rather than from a lack of medical expertise. It has been shown that 70-80 % of such incidents are preventable through special training. Established course concepts based on so-called ABCDE schemes are a good basis for creating algorithms for targeted therapy, yet they are not sufficient for the training of team-specific issues. For this, special course concepts are required, such as crew resource management, which is provided through simulator-based training scenarios. This includes task management, teamwork, decision-making, and communication. The knowledge of what needs to be done in a team under the adverse and complex conditions of a medical emergency must be gained by training based on realistic and effective measures. Course concepts that are geared toward interdisciplinary and interprofessional team training optimize patient safety and care by supporting the nontechnical abilities of team members.

  8. What is 5G? Emerging 5G Mobile Services and Network Requirements

    Directory of Open Access Journals (Sweden)

    Heejung Yu

    2017-10-01

    Full Text Available In this paper, emerging 5G mobile services are investigated and categorized from the perspective of not service providers, but end-users. The development of 5G mobile services is based on an intensive analysis of the global trends in mobile services. Additionally, several indispensable service requirements, essential for realizing service scenarios presented, are described. To illustrate the changes in societies and in daily life in the 5G era, five megatrends, including the explosion of mobile data traffic, the rapid increase in connected devices, everything on the cloud, hyper-realistic media for convergence services and knowledge as a service enabled by big-data analysis, are examined. Based on such trends, we classify the new 5G services into five categories in terms of the end-users’ experience as follows: immersive 5G services, intelligent 5G services, omnipresent 5G services, autonomous 5G services and public 5G services. Moreover, several 5G service scenarios in each service category are presented, and essential technical requirements for realizing the aforementioned 5G services are suggested, along with a competitiveness analysis on 5G services/devices/network industries and the current condition of 5G technologies.

  9. Patient Accounting Systems: Are They Fit with the Users' Requirements?

    Science.gov (United States)

    Ayatollahi, Haleh; Nazemi, Zahra; Haghani, Hamid

    2016-01-01

    A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information.

  10. Patient Accounting Systems: Are They Fit with the Users' Requirements?

    Science.gov (United States)

    Ayatollahi, Haleh; Nazemi, Zahra

    2016-01-01

    Objectives A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. Methods This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Results Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. Conclusions The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information. PMID:26893945

  11. Which pediatric blunt trauma patients do not require pelvic imaging?

    Science.gov (United States)

    Haasz, Maya; Simone, Laura A; Wales, Paul W; Stimec, Jennifer; Stephens, Derek; Beno, Suzanne; Schuh, Suzanne

    2015-11-01

    This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%. This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture. Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs. Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging. Therapeutic study, level IV.

  12. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  13. Caloric requirement of the critically ill septic patient

    International Nuclear Information System (INIS)

    Shizgal, H.M.; Martin, M.F.

    1988-01-01

    The caloric requirement of the critically ill septic patient was determined by measuring body composition, by multiple isotope dilution, before and at 2-wk intervals while receiving total parenteral nutrition (TPN) in 86 septic and 57 nonseptic malnourished patients. All patients received a TPN solution containing 25% dextrose and 2.75% crystalline amino acids. The body composition of the nonseptic patients, who received 51.9 +/- 1.5 kcal/kg.day, improved significantly, while that of the septic patients, receiving 46.8 +/- 1.1 kcal/kg.day was only maintained. The relationship between caloric intake and the restoration of a malnourished body cell mass (BCM) was determined for each group by correlating, using multiple linear regression, the mean daily change in the BCM with the caloric intake and the nutritional state, as determined by body composition. According to the resultant regressions, an intake of 35.1 and 50.7 kcal/kg.day was required to maintain the BCM of the septic and nonseptic patients, respectively. To restore a depleted BCM, caloric intakes in excess of this amount are required

  14. Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

    Directory of Open Access Journals (Sweden)

    Getaw Worku Hassen

    2014-05-01

    Full Text Available Introduction: Contrast-induced nephropathy (CIN, defined as an increase in serum creatinine (SCr greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED and were discharged home after computed tomography (CT of the abdomen and pelvis (AP with IV contrast. Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients’ clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD and congestive heart failure (CHF. Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%. Hypertension was present in 141 patients (26.3%, and 82 patients (15.3% were on angiotensin-converting-enzyme inhibitors (ACEI. Five patients (0.9% had documented CHF and all of them were taking furosemide. Seventy patients (13% had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28% followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5% had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5% developed CIN. One hundred ninety patients (35.4% followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2% had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15% developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients. Conclusion: There was a

  15. Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia.

    Science.gov (United States)

    van der Meer, Dania M; Weiland, Tracey J; Philip, Jennifer; Jelinek, George A; Boughey, Mark; Knott, Jonathan; Marck, Claudia H; Weil, Jennifer L; Lane, Heather P; Dowling, Anthony J; Kelly, Anne-Maree

    2016-03-01

    People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.

  16. Differences in nutrient requirements imply a non-linear emergence of leaders in animal groups.

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    Cédric Sueur

    Full Text Available Collective decision making and especially leadership in groups are among the most studied topics in natural, social, and political sciences. Previous studies have shown that some individuals are more likely to be leaders because of their social power or the pertinent information they possess. One challenge for all group members, however, is to satisfy their needs. In many situations, we do not yet know how individuals within groups distribute leadership decisions between themselves in order to satisfy time-varying individual requirements. To gain insight into this problem, we build a dynamic model where group members have to satisfy different needs but are not aware of each other's needs. Data about needs of animals come from real data observed in macaques. Several studies showed that a collective movement may be initiated by a single individual. This individual may be the dominant one, the oldest one, but also the one having the highest physiological needs. In our model, the individual with the lowest reserve initiates movements and decides for all its conspecifics. This simple rule leads to a viable decision-making system where all individuals may lead the group at one moment and thus suit their requirements. However, a single individual becomes the leader in 38% to 95% of cases and the leadership is unequally (according to an exponential law distributed according to the heterogeneity of needs in the group. The results showed that this non-linearity emerges when one group member reaches physiological requirements, mainly the nutrient ones - protein, energy and water depending on weight - superior to those of its conspecifics. This amplification may explain why some leaders could appear in animal groups without any despotism, complex signalling, or developed cognitive ability.

  17. Evaluation of Knowledge of Emergency Healthcare Workers Regarding Approach to Emergency Patients

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    Özgür Tanr›verdi

    2010-09-01

    Full Text Available Aim: Emergency units constitute the most important part of all hospitals. The aim of this study was to evaluate practitioners’ and healthcare providers’ knowledge and experience regarding emergency first aid in a hospital with insufficient facilities. Methods: 17 physicians and 25 assistant staff working at our hospital were evaluated in terms of their knowledge about and experience in “emergency medicine and trauma” by a questionnaire and by observations. Results: The results of observations and questionnaire indicated that knowledge and experience among physicians were inadequate in terms of basic life support and advanced cardiac life support. This lack of knowledge was not associated with age, time of employment, faculty graduated and training on “emergency medicine” in the group of physicians (r=0.301 p>0.05, r=0.317 p>0.06, r=0.228 p>0.05, r=0.284 p>0.05, respectively and in the group of assistant staff (r=0.341 p>0.05, r=0.287 p>0.06, r=0.234 p>0.05, r=0.227 p>0.05, respectively. Conclusion: Considering that the most of the physicians are gathered in certain regions of our country and that there is a lack of emergency medicine specialists in underdeveloped regions, it has been concluded that physicians specialized in other areas and practitioners must attend emergency medicine trainings under the concept of “emergency medicine rotation”. (The Medical Bulletin of Haseki 2010; 48:103-5

  18. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

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    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  19. [Managing the discharge of diabetic patients from the emergency department: a consensus paper].

    Science.gov (United States)

    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.

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

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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

  1. Patient Satisfaction Analysis in Emergency Department in Imam Reza Hospital of Mashhad

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    Hamidreza Reihani

    2015-01-01

    Conclusion: Attempt for reducing waiting time,  providing comfort environment, increasing  the time of visit with emergency physicians and enhance service quality based on patient needs can reduce the patient dissatisfaction.

  2. Information security requirements in patient-centred healthcare support systems.

    Science.gov (United States)

    Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

    2013-01-01

    Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

  3. An emergency call system for patients in locked-in state using an SSVEP-based brain switch.

    Science.gov (United States)

    Lim, Jeong-Hwan; Kim, Yong-Wook; Lee, Jun-Hak; An, Kwang-Ok; Hwang, Han-Jeong; Cha, Ho-Seung; Han, Chang-Hee; Im, Chang-Hwan

    2017-11-01

    Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios. © 2017 Society for Psychophysiological Research.

  4. The impact of transport of critically ill pediatric patients on rural emergency departments in Manitoba.

    Science.gov (United States)

    Hansen, Gregory; Beer, Darcy L; Vallance, Jeff K

    2017-01-01

    Although the interfacility transport (IFT) of critically ill pediatric patients from rural to tertiary health centres may improve outcomes, the impact of IFTs on the rural referring centre is not known. The purpose of this study was to investigate how the IFT of critically ill children affects staffing and functionality of rural emergency departments (EDs) in Manitoba. In 2015, surveys were emailed to the medical directors of all 15 regional EDs within 2 hours' travel time from a tertiary pediatric hospital. The survey consisted of 9 questions that addressed baseline characteristics of the regional EDs and duration of ED staffing changes or closures due to IFT of critically ill pediatric patients. Ten surveys were received (67% response rate); a regional ED catchment population of about 130 000 people was represented. Interfacility transport caused most EDs (60%, with an average catchment population of 15 000) to close or to alter their staffing to a registered nurse only. These temporary changes lasted a cumulative total of 115 hours. Interfacility transport of critically ill pediatric patients resulted in ED closures and staffing changes in rural Manitoba. These findings suggest that long-term sustainable solutions are required to improve access to emergency care.

  5. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Risk factors for early return visits to the emergency department in patients with urinary tract infection.

    Science.gov (United States)

    Jorgensen, Sarah; Zurayk, Mira; Yeung, Samantha; Terry, Jill; Dunn, Maureen; Nieberg, Paul; Wong-Beringer, Annie

    2018-01-01

    Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI. A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30days (ERVs). We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (Ppregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature≥38 °C heart rate>100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible). Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P=0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P=0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; PUTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Recent Suicidal Ideation among Patients in an Inner City Emergency Department

    Science.gov (United States)

    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…

  8. Clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning and prognosis analysis after rescue.

    Science.gov (United States)

    Dong, Hui; Weng, Yi-Bing; Zhen, Gen-Shen; Li, Feng-Jie; Jin, Ai-Chun; Liu, Jie

    2017-06-01

    This study reports the clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning, and analyzes the prognosis after rescue.The general data of 68 patients with severe organophosphorus poisoning treated in our hospital were retrospectively analyzed. These patients were divided into 2 groups: treatment group, and control group. Patients in the control group received routine emergency treatment, while patients in the treatment group additionally received hemoperfusion plus hemodialysis on the basis of routine emergency treatment. The curative effects in these 2 groups and the prognosis after rescue were compared.Compared with the control group, atropinization time, recovery time of cholinesterase activity, recovery time of consciousness, extubation time, and length of hospital stay were shorter (P poisoning rebound rate was significantly lower (P treatment group.Hemoperfusion and hemodialysis on the basis of routine emergency treatment for critical patients with organophosphorus poisoning can improve rescue outcomes and improve the prognosis of patients, which should be popularized.

  9. Evaluation of emergency department nursing services and patient satisfaction of services.

    Science.gov (United States)

    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.

  10. Investigating the effect of clinical governess approach on patients' length of stay in emergency department: an action research study.

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    Tahmine Salehi

    2014-02-01

    Full Text Available Over the past decade, clinical governance approach with aims to improve the quality of health services has been proposed in Iran. Considering the obvious problems especially patients' length of stay (LOS in the emergency departments (EDs; the present study has been carried out with the purpose of Investigating the effect of clinical governess approach on patients' LOS in the one of the largest medical centers in the country. After the problem was specified by the 17 interviews with employees and managers of the ED; the emergency clinical governance committee was formed by two academic researchers and seven ED staff (key participants that had the most involvement with the subject of study. The activities of the committee, including planning, acting, observing and reflecting, was organized by using participatory action research approach and action research cycle (Kemmis 1995. During this time, three formal meetings with key participants were held in 6-month intervals. Monthly records of patients' average LOS and interview with ED staff were used to analyze the findings. The research was completed with two cycles in one year. Committee members took the following actions. As a result, the patients' LOS reduced from 2.68 days to 1.73 days. Make regular patients visits by medical groups especially orthopedists and neurologists; Decision making about patients situation by emergency physicians and transferring patients to the relevant units by bed managers; Refusing to admit elective patients during overcrowding times; to regulate the list of patients requiring ICU by anesthesiologists. Prolonged LOS can be due to various causes and a team approach, which is one of the requirements of clinical governance approach, is needed to manage it. The results showed that the multidisciplinary team could make positive changes and reduce LOS in emergency setting.

  11. Persistent lymphopenia is an independent predictor of mortality in critically ill emergency general surgical patients.

    Science.gov (United States)

    Vulliamy, P E; Perkins, Z B; Brohi, K; Manson, J

    2016-12-01

    Lymphopenia has been associated with poor outcome following sepsis, burns and trauma. This study was designed to establish whether lymphocyte count was associated with mortality in emergency general surgery (EGS) patients, and whether persistent lymphopenia was an independent predictor of mortality. A retrospective review of a prospectively compiled database of adult patients requiring ICU admission between 2002 and 2013 was performed. EGS patients with acute intra-abdominal pathology and organ dysfunction were included. Lymphocyte counts obtained from the day of ICU admission through to day 7 were examined. Multivariate logistic regression models were used to determine the relationship between persistent lymphopenia and outcome. The primary outcome measure was in-hospital mortality. The study included 173 patients, of whom 135 (78 %) had a low lymphocyte count at admission to ICU and 91 % (158/173) developed lymphopenia on at least one occasion. Lymphocyte counts were lower among non-survivors compared with survivors on each day from day 2 (0.62 vs 0.81, p = 0.03) through to day 7 (0.87 vs 1.15, p < 0.01). Patients with a persistently low lymphocyte count during the study period had significantly higher mortality when compared to patients with other lymphocyte patterns (64 vs 29 %, p < 0.01). On multivariate regression analysis, persistent lymphopenia was independently associated with increased in-hospital mortality [odds ratio 3.5 (95 % CI 1.7-7.3), p < 0.01]. Lymphopenia is commonly observed in critically ill EGS patients. Patients with persistent lymphopenia are 3.5 times more likely to die and lymphopenia is an independent predictor of increased mortality in this patient group.

  12. The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation.

    Science.gov (United States)

    Mahmood, Kamran; Wahidi, Momen M

    2016-12-01

    Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Medical evaluation of the pregnant patient requiring nonobstetric surgery

    International Nuclear Information System (INIS)

    Barron, W.M.

    1985-01-01

    This article provides a summary of currently available information from a broad range of disciplines aimed at guiding the physician caring for the pregnant patient who requires nonobstetric surgery. An understanding of the anatomic and physiologic alterations that occur during pregnancy will allow such procedures to be accomplished with morbidity and mortality approaching those of nonpregnant surgical patients. The presence of the fetus does impose some restraint; however, this should rarely impair appropriate diagnosis and treatment of maternal disease. This obtains from the broad range of diagnostic and therapeutic alternatives available, and from the fact that what is beneficial for maternal health is generally best for the fetus. 64 references

  14. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    Science.gov (United States)

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-09-01

    National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification. The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.

  15. Signs and symptoms of patients with brain tumors presenting to the emergency department.

    Science.gov (United States)

    Snyder, H; Robinson, K; Shah, D; Brennan, R; Handrigan, M

    1993-01-01

    This retrospective chart review was conducted to determine the presenting signs and symptoms of patients with primary brain tumors diagnosed in the emergency department. There were 101 patients (65 males and 36 females) identified with a hospital discharge diagnosis of primary brain tumor who were admitted through the emergency department. The presenting symptoms included headache (56 patients), altered mental status (51 patients), ataxia (41 patients), nausea or vomiting (37 patients), weakness (27 patients), speech deficits (21 patients), and sensory abnormalities (18 patients). The presenting signs included motor weakness (37 patients), ataxia (37 patients), papilledema (28 patients), cranial nerve palsies (26 patients), visual deficits (20 patients), and speech deficits (12 patients). The average age was 42.8 years, with a range of 3 days to 88 years. The majority of tumors were malignant astrocytomas. Tumor location was cortical in 68 patients, subcortical in 9 patients, and brainstem or cerebellum in 24 patients. In conclusion, patients of all ages may present to the emergency department with a variety of symptoms resulting from a primary brain tumor. Headache and altered mental status were common in our series of patients, but symptoms will depend on the size, location, and type of tumor. A complete neurologic examination is essential, including evaluation for papilledema.

  16. The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury

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    Frank Xavier Scheuermeyer

    2017-04-01

    Full Text Available Background: Acute kidney injury (AKI is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1 the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2 the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7% with a median age of 74 and 70% male. Of the 31 (34.4% AKI patients discharged home, 4 (12.9% had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%. Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a

  17. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie......, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs. RELEVANCE TO CLINICAL PRACTICE: Intermediate care may increase patient perceptions of quality and safety of care.......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...

  18. 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...

  19. Increase in pediatric magnet-related foreign bodies requiring emergency care.

    Science.gov (United States)

    Silverman, Jonathan A; Brown, Julie C; Willis, Margaret M; Ebel, Beth E

    2013-12-01

    We describe magnetic foreign body injuries among children and obtain national estimates of magnetic foreign body injury incidence over time. We searched the National Electronic Injury Surveillance System for cases of magnetic foreign bodies in children younger than 21 years in the United States, from 2002 to 2011. Cases were analyzed by location: alimentary or respiratory tract, nasal cavity, ear canal, or genital area. We identified 893 cases of magnetic foreign bodies, corresponding to 22,581 magnetic foreign body cases during a 10-year period (95% confidence interval [CI] 17,694 to 27,469). Most magnetic foreign bodies were ingested (74%) or intranasal (21%). Mean age was 5.2 years for ingested magnetic foreign bodies and 10.1 years for nasal magnetic foreign bodies (difference 4.9; 95% CI 4.1 to 5.6), suggesting different circumstances of injury. The incidence of pediatric magnet ingestions increased from 2002 to 2003 from 0.57 cases per 100,000 children per year (95% CI 0.22 to 0.92) to a peak in 2010 to 2011 of 3.06 cases per 100,000 children per year (95% CI 2.16 to 3.96). Most ingested magnetic foreign bodies (73%) and multiple magnet ingestions (91%) occurred in 2007 or later. Patients were admitted in 15.7% of multiple magnet ingestions versus 2.3% of single magnet ingestions (difference 13.4%; 95% CI 2.8% to 24.0%). Magnet-related injuries are an increasing public health problem for young children, as well for older children who may use magnets for play or to imitate piercings. Education and improved magnet safety standards may decrease the risk small magnets pose to children. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  20. Forensic patients in the emergency department: Who are they and how should we care for them?

    Science.gov (United States)

    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.

  1. Does Targeted Education of Emergency Physicians Improve Their Comfort Level in Treating Psychiatric Patients?

    Directory of Open Access Journals (Sweden)

    Brenda J Walker

    2012-12-01

    Full Text Available Introduction: We determined if targeted education of emergency physicians (EPsregarding the treatment of mental illness will improve their comfort level in treatingpsychiatric patients boarding in the emergency department (ED awaiting admission.Methods: We performed a pilot study examining whether an educational interventionwould change an EP’s comfort level in treating psychiatric boarder patients (PBPs. Weidentified a set of psychiatric emergencies that typically require admission or treatmentbeyond the scope of practice of emergency medicine. Diagnoses included majordepression, schizophrenia, schizoaffective disorder, bipolar affective disorder, generalanxiety disorder, suicidal ideation, and criminal behavior. We designed equivalentsurveys to be used before and after an educational intervention. Each survey consistedof 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levelsin treating the described patients on a visual analogue scale. We calculated summaryscores for the non intervention survey group (NINT and intervention survey group (INTand compared them using Student’s t-test.Results: Seventy-nine percent (33/42 of eligible participants completed the preinterventionsurvey (21 attendings, 12 residents and comprised the NINT group. Fiftyfivepercent (23/42 completed the post-intervention survey (16 attendings, 7 residentscomprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’groups showed a highly significant improvement in comfort levels with treating thepatients described in the scenarios (P = 0.003. Improvements were noted on separateanalysis for faculty (P = 0.039 and for residents (P = 0.012. Results of a sensitivityanalysis excluding one highly significant scenario showed decreased, but still importantdifferences between the NINT and INT groups for all participants and for residents, butnot for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0

  2. Psychometric testing of the Agitation Severity Scale for acute presentation behavioral management patients in the emergency department.

    Science.gov (United States)

    Strout, Tania D

    2014-01-01

    Agitation is a vexing problem frequently observed in emergency department acute psychiatric patients, yet no instruments to measure agitation in this setting and population were found upon review of the literature. Previously developed agitation rating scales are limited by the length of observation they require, their need for participation by the patient, complexity in scoring, and a lack of validity in this setting and population. The purpose of this study was to psychometrically evaluate and refine an observation-based agitation scale for use with emergency department acute psychiatric patients. Using a methodological design, the 21-item Agitation Severity Scale was utilized to assess 270 adult psychiatric patients in the emergency setting in a prospective, observational fashion. Reliability analysis, item analysis, exploratory factor analysis, and validity assessments were completed. The relationship between Agitation Severity Scale scores and scores on the previously established Overt Agitation Severity Scale was evaluated. The instrument was reduced to 17 items representing four factors (Aggressive Behaviors, Interpersonal Behaviors, Involuntary Motor Behaviors, and Physical Stance) that accounted for nearly 70% of observed variance, Cronbach's α = 0.91. Evidence of internal consistency reliability, equivalence reliability, construct validity, and convergent validity was established. Through this study, the 17-item Agitation Severity Scale demonstrated acceptable levels of reliability and validity when used with acute psychiatric patients in the emergency setting. This instrument holds promise as a method of enhancing clinical communication about agitation, evaluating the efficacy of interventions aimed at decreasing agitation, and as a research tool.

  3. Dose assessment of the patient and the helper in emergency head computed tomography

    International Nuclear Information System (INIS)

    Chang, Rong-Chou; Yu, Cheng-Ching; Hsu, Fang-Yuh; Chen, Tou-Rong; Hsu, Shih-Ming; Tyan, Yeu-Sheng

    2011-01-01

    Computed Tomography (CT) becomes more and more important and is frequently used in modern diagnostic techniques. CT offers an effective diagnosis on lesion and pathology; however, it also delivers a radiation dose to patients. Besides, in some special emergency cases, the patient may require someone to help him in the examination room to perform the head CT, due to the patient lost intellectual and operational capacity. This study evaluated the delivered radiation dose and the risk of radiation-induced cancer for the patient and for the helper after carrying out the emergent head CT examination. A Rando phantom with thermoluminescent dosimeter (TLD) chips inside relevant organs was used to simulate the patient during head CT examination. An effective dose of 2.06 ± 0.16 mSv and 1.46 ± 0.07 mSv without and with wearing the lead apron were found respectively, considering ICRP 60 recommendation. ICRP 103 recommendations the readings would have been 1.29 ± 0.15 mSv and 0.71 ± 0.04 mSv. The effective dose determined from the dose-length product (DLP) method (2.19 mSv) was similar to the value (2.06 ± 0.16 mSv) estimated by TLD method considering the ICRP 60 recommendation (without lead apron). Assuming a 5% total risk for fatal cancer per Sv in the general population, risk of radiation-induced cancer for patients were 1.03 × 10 −2 % (without lead apron) and 7.80 × 10 −3 % (with lead apron) for ICRP 60, and were 6.45 × 10 −3 % (without lead apron) and 3.55 × 10 −3 % (with lead apron) for ICRP 103. The dose received by the helper was assessed by wearing a personal badge. The helper during emergent head CT examination may receive a personal dose equivalent (H p (10)) of 19.36 ± 5.89 μSv and 138.81 ± 101.28 μSv with and without lead apron, respectively, at distance of 0.3–1 m from the center of CT scanner. Based on the observed dose reduction of a factor of 7.17 we recommend that helpers wear lead apron in the CT examination room.

  4. Successful intraosseous infusion in the critically ill patient does not require a medullary cavity.

    LENUS (Irish Health Repository)

    McCarthy, Gerard

    2012-02-03

    OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.

  5. THREAT helps to identify epistaxis patients requiring blood transfusions

    Science.gov (United States)

    2013-01-01

    Objective To analyze the characteristics of patients who needed a blood transfusion due to epistaxis-caused anemia and to define potential risk factors. Design Retrospective cohort study. Setting A total cohort of 591 epistaxis patients, prospectively included between March 2007 and April 2008 at the ENT department of the University Hospital of Zurich, was evaluated concerning the need for blood transfusions. Methods The clinical charts and medical histories of these patients were evaluated. Main outcome measures Common parameters that increase the risk for severe anemia due to epistaxis. Results Twenty-two patients required blood transfusions due to their medical condition. 22.7% suffered from traumatic nosebleeds. Another 27.3% had a known medical condition with an increased bleeding tendency. These proportions were significantly higher than in the group of patients without need of blood transfusion. The odds ratio for receiving a blood transfusion was 14.0 in patients with hematologic disorders, 4.3 in traumatic epistaxis and 7.7 in posterior bleeders. The transfusion-dependent epistaxis patients suffered significantly more often from severe posterior nosebleeds with the need for a surgical therapeutic approach. Conclusions Patients with severe nosebleeds either from the posterior part of the nose or with known hematologic disorders or traumatic epistaxis should be closely monitored by blood parameter analyses to evaluate the indication for hemotransfusion. The acronym THREAT (Trauma, Hematologic disorder, and REAr origin of bleeding → Transfusion) helps to remember and identify the factors associated with an increased risk of receiving blood transfusion. PMID:23663751

  6. Health Literacy Among Parents of Pediatric Patients Seen in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Tran, T. Paul

    2008-08-01

    Full Text Available BACKGROUND: Health literacy is an important predictor of healthcare outcomes, but research on this topic has largely been absent from the emergency medicine literature.OBJECTIVE: We measured the prevalence of health literacy in parents or guardians of pediatric patients seen in the emergency department (ED.METHODS: This was an observational study conducted in a Midwestern urban, university-based, tertiary, Level 1 trauma center ED with 33,000 visits/year. Using convenience sampling during a three-month period, English-speaking parents or guardians of pediatric patients (< 19 yrs. were asked to complete the short version of the Test of Functional Health Literacy for Adults (s-TOFHLA. Parents/guardians were excluded if they had uncorrected visual impairment, required an interpreter, had altered mental status, or if the patients they accompanied were the subjects of a medical or trauma activation.RESULTS: Of the 188 parents or guardians approached, six did not consent or withdrew, one was excluded, leaving 181 (96.3% in the study. Of these, 19 (10.5% had either "marginal" or "inadequate" health literacy, while 162 (89.5%, 95% CI: 84.1%, 93.6% had "adequate" health literacy.CONCLUSION: A large majority (89.5% of English-speaking parents or guardians of pediatric patients evaluated in the ED have adequate health literacy. This data may prompt ED professionals to adjust their communication styles in the evaluation of children. Future multi-center studies are needed to confirm the findings in this pilot study.

  7. Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments.

    Science.gov (United States)

    Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G; Hupert, Nathaniel; Lurie, Nicole

    2017-10-01

    National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

  8. The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng.

    Science.gov (United States)

    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.

  9. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

    2017-01-01

    ) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

  10. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

    ) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

  11. Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients

    Directory of Open Access Journals (Sweden)

    Durand Anne-Claire

    2012-09-01

    Full Text Available Abstract Background For several decades, overcrowding in emergency departments (EDs has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of “nonurgency”. Results Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1 fulfilled health care needs, (2 barriers to primary care providers (PCPs, and (3 convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1 the problem of defining a nonurgent visit, (2 explanations for patients’ use of EDs for nonurgent complaints, (3 consequences of nonurgent visits, and (4 solutions to counter this tendency. Conclusions Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred. In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed

  12. Optimum dietary protein requirement in nondiabetic maintenance hemodialysis patients.

    Science.gov (United States)

    Ohkawa, Sakae; Kaizu, Yukiko; Odamaki, Mari; Ikegaya, Naoki; Hibi, Ikuo; Miyaji, Kunihiko; Kumagai, Hiromichi

    2004-03-01

    There is controversy about whether the dietary protein requirement of 1.2 g/kg/d for hemodialysis (HD) patients, in the nutritional guidelines recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), is reasonable. A cross-sectional study was conducted in 129 stable HD patients without diabetes (84 men, 45 women) to investigate the association between the protein equivalent of nitrogen appearance normalized by ideal body weight (nPNAibw), an index of protein intake, and skeletal muscle mass or other metabolic consequences. Patients were divided into 5 groups according to nPNAibw index. Midthigh muscle area (TMA), midthigh subcutaneous fat area (TSFA), abdominal muscle area (AMA), abdominal subcutaneous fat area (ASFA), and visceral fat area (AVFA) were measured using computed tomography, and various nutritional parameters were compared among these groups. TMA and AMA values increased with increasing dietary protein intake from less than 0.7 g/kg/d to 0.9-1.1 g/kg/d and showed a plateau at greater than 0.9 to 1.1 g/kg/d of dietary protein intake. Conversely, fat mass, including TSFA, ASFA, and AVFA, and serum potassium concentration increased with graded protein intake, and no plateau was formed. Patients with nPNAibw greater than 1.3 g/kg/d satisfied the criterion of visceral obesity. Although serum prealbumin levels showed a trend similar to that of muscle mass, there was no significant difference in serum albumin levels among the study groups. Optimal dietary protein requirement for patients undergoing maintenance HD in a stable condition appears to be less than the level recommended by the NKF-KDOQI nutritional guidelines.

  13. 18 CFR 376.209 - Procedures during periods of emergency requiring activation of the Continuity of Operations Plan.

    Science.gov (United States)

    2010-04-01

    ... periods of emergency requiring activation of the Continuity of Operations Plan. 376.209 Section 376.209... of the Continuity of Operations Plan. (a)(1) The Commission's Continuity of Operations Plan is...) During periods when the Continuity of Operations Plan is activated, the Commission will continue to act...

  14. Wait times in the emergency department for patients with mental illness

    Science.gov (United States)

    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

  15. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    Science.gov (United States)

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

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

    Science.gov (United States)

    Pulliam, Bryce C.; Liao, Mark Y.; Geissler, Theodore M.; Richards, John R.

    2013-01-01

    Introduction: The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding. It also assessed their preferred boarding location if they were patients. Methods: A survey administered to a convenience sample of ED and W nurses was performed in a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/ year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. The nurses were asked if there were any circumstances where admitted patients should be boarded in ED or W hallways. They were also asked their preferred location if they were admitted as a patient. Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on each scenario were queried. Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were current ED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46 (52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to W boarding, with 20% of cED versus 83% of current W (cW) nurses (P boarding, with 82% of cED versus 33% of cW nurses (P boarding were lack of monitoring and patient privacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existed in all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen, and an intubated, unstable sepsis patient. Conclusion: Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work

  17. Comparison between emergency department and inpatient nurses' perceptions of boarding of admitted patients.

    Science.gov (United States)

    Pulliam, Bryce C; Liao, Mark Y; Geissler, Theodore M; Richards, John R

    2013-03-01

    The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways. This study queried and compared ED and W nurses' opinions toward ED and W boarding. It also assessed their preferred boarding location if they were patients. A survey administered to a convenience sample of ED and W nurses was performed in a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/ year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. The nurses were asked if there were any circumstances where admitted patients should be boarded in ED or W hallways. They were also asked their preferred location if they were admitted as a patient. Six clinical scenarios were then presented, and the nurses' opinions on boarding based on each scenario were queried. Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were current ED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46 (52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to W boarding, with 20% of cED versus 83% of current W (cW) nurses (P boarding, with 82% of cED versus 33% of cW nurses (P boarding were lack of monitoring and patient privacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existed in all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen, and an intubated, unstable sepsis patient. Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work. ED and inpatient nurses seemed to agree that

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

    Directory of Open Access Journals (Sweden)

    Bryce C. Pulliam

    2013-03-01

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

  19. Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

    Science.gov (United States)

    Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna

    2009-01-01

    The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

  20. External validation of the Emergency Trauma Score for early prediction of mortality in trauma patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Reitsma, Johannes B.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel

    2014-01-01

    The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and

  1. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base

  2. Confronting Ethical and Regulatory Challenges of Emergency Care Research With Conscious Patients.

    Science.gov (United States)

    Dickert, Neal W; Brown, Jeremy; Cairns, Charles B; Eaves-Leanos, Aaliyah; Goldkind, Sara F; Kim, Scott Y H; Nichol, Graham; O'Conor, Katie J; Scott, Jane D; Sinert, Richard; Wendler, David; Wright, David W; Silbergleit, Robert

    2016-04-01

    Barriers to informed consent are ubiquitous in the conduct of emergency care research across a wide range of conditions and clinical contexts. They are largely unavoidable; can be related to time constraints, physical symptoms, emotional stress, and cognitive impairment; and affect patients and surrogates. US regulations permit an exception from informed consent for certain clinical trials in emergency settings, but these regulations have generally been used to facilitate trials in which patients are unconscious and no surrogate is available. Most emergency care research, however, involves conscious patients, and surrogates are often available. Unfortunately, there is neither clear regulatory guidance nor established ethical standards in regard to consent in these settings. In this report-the result of a workshop convened by the National Institutes of Health Office of Emergency Care Research and Department of Bioethics to address ethical challenges in emergency care research-we clarify potential gaps in ethical understanding and federal regulations about research in emergency care in which limited involvement of patients or surrogates in enrollment decisions is possible. We propose a spectrum of approaches directed toward realistic ethical goals and a research and policy agenda for addressing these issues to facilitate clinical research necessary to improve emergency care. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  3. [Surgical treatment of Marfan syndrome; analysis of the patients required multiple surgical interventions].

    Science.gov (United States)

    Yamazaki, F; Shimamoto, M; Fujita, S; Nakai, M; Aoyama, A; Chen, F; Nakata, T; Yamada, T

    2002-07-01

    Without treatment, the life expectancy of patients with Marfan syndrome is reduced by the associated cardiovascular abnormalities. In this study, we reviewed our experience of the patients with Marfan syndrome who required multiple surgical interventions to identify the optimal treatment for these patients. Between January 1986 and December 2000, 44 patients with Marfan syndrome were operated on at Shizuoka City Hospital (SCH). Among them, 10 patients (22.7%) underwent multiple surgical interventions. There were 5 male and 5 female patients with a mean age of 40.6 +/- 16.1 years at the initial surgery. Only one patient was operated on at another hospital for his first, second, and third operations. His fourth operation was carried out at SCH. The remaining 9 patients underwent a total of 14 additional surgical procedures at SCH. Computed tomography (CT) scans were taken every 6 months postoperatively, and aortic diameter greater than 60 mm was considered as the indication for the additional surgery. There were no early death and one late death. The causes of additional surgery were enlargement of true aneurysm in 6, enlargement of residual dissection in 4, new dissection in 4, false aneurysm at the coronary anastomosis of Bentall procedure in 1. In 9 patients, both ascending and descending aorta were replaced. Among these 9 patients, only 3 patients underwent total arch replacement, and remaining 6 patients had their arch left in place with or without dissection. Our current strategy of the treatment of Marfan patients with acute type A dissection is total arch replacement with an elephant trunk at the initial emergent surgery.

  4. The unexpected in primary care: a multicenter study on the emergence of unvoiced patient agenda.

    NARCIS (Netherlands)

    Peltenburg, M.; Fischer, J.E.; Bahrs, O.; Dulmen, S. van; Brink-Muinen, A. van den

    2004-01-01

    PURPOSE: Within the time constraints of a typical physician-patient encounter, the full patient agenda will rarely be voiced. Unexpectedly revealed issues that were neither on the patient's list of items for discussion nor anticipated by the physician constitute an emerging agenda. We aimed to

  5. Blood leptin levels and erythropoietin requirement in Iranian hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rahimi A

    2008-12-01

    Full Text Available "nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need. "nMethods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated. "nResults: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin; it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need. "nConclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.

  6. Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

    Directory of Open Access Journals (Sweden)

    Miguel Gus

    1999-03-01

    Full Text Available OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3% complained of high BP, and 61 (76.3% received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%. One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5% were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits. Currently, the therapeutic approach is not recommended, even in specialized clinics.

  7. What does respect for the patient's autonomy require?

    Science.gov (United States)

    Cheng, Kam-Yuen

    2013-11-01

    Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows. © 2012 John Wiley & Sons Ltd.

  8. Patient outcome of emergency laparotomy improved with increasing "number of surgeons on-call" in a university hospital: Audit loop.

    Science.gov (United States)

    Hussain, Anwar; Mahmood, Fahad; Teng, Chui; Jafferbhoy, Sadaf; Luke, David; Tsiamis, Achilleas

    2017-11-01

    Emergency laparotomy is a commonly performed high-mortality surgical procedure. The National Emergency Laparotomy Network (NELA) published an average mortality rate of 11.1% and a median length of stay equivalent to 16.3 days in patients undergoing emergency laparotomy. This study presents a completed audit loop after implementing the change of increasing the number of on-call surgeons in the general surgery rota of a university hospital. The aim of this study was to evaluate the outcomes of emergency laparotomy in a single UK tertiary centre after addition of one more consultant in the daily on-call rota. This is a retrospective study involving patients who underwent emergency laparotomy between March to May 2013 (first audit) and June to August 2015 (second audit). The study parameters stayed the same. The adult patients undergoing emergency laparotomy under the general surgical take were included. Appendicectomy, cholecystectomy and simple inguinal hernia repair patients were excluded. Data was collected on patient demographics, ASA, morbidity, 30-day mortality and length of hospital stay. Statistical analysis including logistic regression was performed using SPSS. During the second 3-month period, 123 patients underwent laparotomy compared to 84 in the first audit. Median age was 65(23-93) years. 56.01% cases were ASA III or above in the re-audit compared to 41.9% in the initial audit. 38% patients had bowel anastomosis compared to 35.7% in the re-audit with 4.2% leak rate in the re-audit compared to 16.6% in the first audit. 30-day mortality was 10.50% in the re-audit compared to 21% and median length of hospital stay 11 days in the re-audit compared to 16 days. The lower ASA grade was significantly associated with increased likelihood of being alive, as was being female, younger age and not requiring ITU admission post-operatively. However, having a second on-call consultant was 2.231 times more likely to increase the chances of patients not dying (p = 0

  9. Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution.

    Science.gov (United States)

    Shartar, Samuel E; Moore, Brooks L; Wood, Lori M

    2017-12-01

    Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care. Working with hospitals within the region, we refined emergency department surge capacity for MCIs and developed a prepopulated tool for EMS providers to use to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to nontrauma hospitals. A mechanism to remove a hospital from the list of available resources, if it is overwhelmed with patients who self-transport to the location, also was put into place. The number of critically injured survivors from an MCI has proven to be consistent, averaging 7% to 10%. Moving critically injured patients to level 1 trauma centers can result in a 25% reduction in mortality, when compared with care at nontrauma hospitals. US cities face major gaps in the surge capacity needed to manage an MCI. Sixty percent of "walking wounded" casualties self-transport to the closest hospital(s) to the incident. Directing critically ill patients to designated trauma centers has the potential to reduce mortality associated with the event. When applied to MCI responses, damage-control principles reduce resource utilization and optimize surge capacity. A universal system for mass casualty triage was identified and incorporated into the region's EMS. Flagship regional coordinating hospitals were designated

  10. Factors Associated with Decision to Hospitalize Emergency Department Patients with Skin and Soft Tissue Infection

    Directory of Open Access Journals (Sweden)

    Talan, David A.

    2014-12-01

    Full Text Available Introduction: Emergency department (ED hospitalizations for skin and soft tissue infection (SSTI have increased, while concern for costs has grown and outpatient parenteral antibiotic options have expanded. To identify opportunities to reduce admissions, we explored factors that influence the decision to hospitalize an ED patient with a SSTI. Methods: We conducted a prospective study of adults presenting to 12 U.S. EDs with a SSTI in which physicians were surveyed as to reason(s for admission, and clinical characteristics were correlated with disposition. We employed chi-square binary recursive partitioning to assess independent predictors of admission. Serious adverse events were recorded. Results: Among 619 patients, median age was 38.7 years. The median duration of symptoms was 4.0 days, 96 (15.5% had a history of fever, and 46 (7.5% had failed treatment. Median maximal length of erythema was 4.0cm (IQR, 2.0-7.0. Upon presentation, 39 (6.3% had temperature >38oC, 81 (13.1% tachycardia, 35 (5.7%, tachypnea, and 5 (0.8% hypotension; at the time of the ED disposition decision, these findings were present in 9 (1.5%, 11 (1.8%, 7 (1.1%, and 3 (0.5% patients, respectively. Ninety-four patients (15.2% were admitted, 3 (0.5% to the intensive care unit (ICU. Common reasons for admission were need for intravenous antibiotics in 80 (85.1%; the only reason in 41.5%, surgery in 23 (24.5%, and underlying disease in 11 (11.7%. Hospitalization was significantly associated with the following factors in decreasing order of importance: history of fever (present in 43.6% of those admitted, and 10.5% discharged; maximal length of erythema >10cm (43.6%, 11.3%; history of failed treatment (16.1%, 6.0%; any co-morbidity (61.7%, 27.2%; and age >65 years (5.4%, 1.3%. Two patients required amputation and none had ICU transfer or died. Conclusion: ED SSTI patients with fever, larger lesions, and co-morbidities tend to be hospitalized, almost all to non-critical areas

  11. The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng

    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

  12. Prevention and treatment of emergencies in thyroid patients

    Directory of Open Access Journals (Sweden)

    Anatoliy Filippovich Romanchishen

    2015-03-01

    Thyroid Surgery needs precise knowledge of skull base, neck and mediastinum anatomy, safety resection of thyroid, parathyroid, under RLN visual control, thorough hemostasis and closely postoperative watching for patients.

  13. Quantitative analysis of the level of readability of online emergency radiology-based patient education resources.

    Science.gov (United States)

    Hansberry, David R; D'Angelo, Michael; White, Michael D; Prabhu, Arpan V; Cox, Mougnyan; Agarwal, Nitin; Deshmukh, Sandeep

    2018-04-01

    The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology. Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales. The search terms included the following: abdominal ultrasound, abdominal aortic aneurysm, aortic dissection, appendicitis, cord compression, CT abdomen, cholecystitis, CT chest, diverticulitis, ectopic pregnancy, epidural hematoma, dural venous thrombosis, head CT, MRI brain, MR angiography, MRI spine, ovarian torsion, pancreatitis, pelvic ultrasound, pneumoperitoneum, pulmonary embolism, subarachnoid hemorrhage, and subdural hematoma. Any content that was not written for patients was excluded. The 230 articles that were assessed were written, on average, at a 12.1 grade level. Only 2 of the 230 articles (1%) were written at the third to seventh grade recommended reading level set forth by the National Institutes of Health (NIH) and American Medical Association (AMA). Fifty-two percent of the 230 articles were written so as to require a minimum of a high school education (at least a 12th grade level). Additionally, 17 of the 230 articles (7.3%) were written at a level that exceeded an undergraduate education (at least a 16th grade level). The majority of websites with emergency radiology-related patient education materials are not adhering to the NIH and AMA's recommended reading levels, and it is likely that the average reader is not benefiting fully from these information outlets. With the link between health literacy and poor health outcomes, it is important to address the online content in this area of radiology, allowing for patient to more fully benefit

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

    Science.gov (United States)

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

    2015-09-01

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

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

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...... triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US......) in patients with respiratory symptoms, the typical objectives would be to identify pericardial effusion and enlargement of cardiac cavities, to estimate global systolic left-ventricular function, and to assess the volume status. The routine use of focused cardiac US in patients with respiratory symptoms may...

  16. Clinical characteristics and outcomes for patients with an initial emergency presentation of malignancy: a 15 month audit of patient level data.

    Science.gov (United States)

    Savage, Philip; Sharkey, Rachel; Kua, Teresa; Papanastasopoulos, Panagiotis; McDonald-Burrows, Zoe; Hassan, Shazalia; Probst, Fay; Sanders, Ali; Millington, Hugh

    2015-02-01

    To investigate the demographics, diagnoses and outcomes for new adult cancer patients with an initial presentation via the A&E or acute oncology teams. Patients with initial emergency presentation of malignancy have been documented to have poorer treatment outcomes and shorter survival. Patient level data on this subject is relatively limited with regard to the demographics, diagnoses and the clinical factors that may underlie late presentations. A 15 month audit of the patients presenting with a new diagnosis of malignancy was performed in 2011-2012. Data on demographics, diagnosis and outcome were assembled and analysed. The clinical data on emergency presentations were compared to reference information on the incidence and median age at presentation for each malignancy within the standard population. During the study a total of 178 new cancer patients presented via the A and E service. The most frequent diagnoses were lung cancer with 21% of cases and CNS and colorectal cancer each with 9% of cases. There was a higher incidence of emergency new presentations of lung cancer, CNS tumours, ovarian, pancreatic and testicular cancer than in the standard population, whilst breast cancer, bladder cancer and prostate cancer patients were under-represented. The median age at diagnosis was 74 and for a number of malignancies including CNS tumours, breast cancer, colorectal cancer and head and neck cancer the emergency cases presented at significantly greater ages than in the standard population. Overall 27% of patients were unfit or unsuitable for a diagnostic biopsy, this group had only a 3 month median survival compared to 14 months for those suitable for biopsy and treatment. Despite a wide range of initiatives, the emergency and late diagnosis of patients with metastatic cancer remains a significant challenge with many patients too advanced and unwell at presentation for active treatment. These patients tend to be older and have malignancies that present with either

  17. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities

    OpenAIRE

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed u...

  18. [Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem].

    Science.gov (United States)

    Jiménez Busselo, M T; Aragó Domingo, J; Nuño Ballesteros, A; Loño Capote, J; Ochando Perales, G

    2005-12-01

    Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients. Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase. The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit. Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case. This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. It is advisable, therefore, that health professionals become familiar with the distinct pharmacological options.

  19. Techniques for improving efficiency in the emergency department for patients with acute ischemic stroke.

    Science.gov (United States)

    Jauch, Edward C; Holmstedt, Christine; Nolte, Justin

    2012-09-01

    The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability. © 2012 New York Academy of Sciences.

  20. Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits

    Directory of Open Access Journals (Sweden)

    Inna Kaminecki

    2018-01-01

    Full Text Available While the incidence of acute rheumatic fever (ARF in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the disease and clinical presentation that can mimic other conditions. We present the case of a 5-year-old boy with a history of intermittent fevers, fatigue, migratory joint pain, and weight loss following group A Streptococcus pharyngitis. The patient presented to the emergency department twice with the complaints described above. On his 3rd presentation, the workup for his symptoms revealed the diagnosis of acute rheumatic fever with severe mitral and aortic valve regurgitation. The patient was treated with penicillin G benzathine and was started on glucocorticoids for severe carditis. The patient was discharged with recommendations to continue secondary prophylaxis with penicillin G benzathine every 4 weeks for the next 10 years. This case illustrates importance of primary prevention of acute rheumatic fever with adequate antibiotic treatment of group A Streptococcus pharyngitis. Parents should also receive information and education that a child with a previous attack of ARF has higher risk for a recurrent attack of rheumatic fever. This can lead to development of severe rheumatic heart disease. Prevention of recurrent ARF requires continuous antimicrobial prophylaxis. Follow-up with a cardiologist every 1-2 years is essential to assess the heart for valve damage.

  1. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-03

    Although it is widely accepted that aspirin will increase the risk of intra- and post-operative bleeding, clinical studies have not consistently supported this assumption. We aimed to assess the effect of pre-operative aspirin on blood loss and transfusion requirements in patients undergoing emergency fixation of femoral neck fractures. A prospective case-control study was undertaken in patients presenting with femoral neck fractures. Parameters recorded included intra-operative blood loss, post-operative blood loss, transfusion requirements and peri-operative reduction in haemoglobin concentration. Of 89 patients presenting with femoral neck fractures 32 were on long-term aspirin therapy. Pre-operative aspirin ingestion did not significantly affect peri-operative blood loss, or change in haemoglobin concentration or haematocrit. However those patients taking aspirin pre-operatively had a significantly lower haemoglobin concentration and haematocrit and were more likely to be anaemic at presentation than those who were not receiving aspirin. Patients taking aspirin were also more likely to receive blood transfusion post-operatively.

  2. Patients in prehospital transport to the emergency department

    DEFF Research Database (Denmark)

    Bech, Camilla Louise Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren

    2018-01-01

    in the prehospital setting and 7-day mortality. RESULTS: A total of 32 076 ambulance transfers were recorded. Of these, 20 328 were first-time transfers, including 2692 that received assistance from a physician-staffed mobile emergency care unit (MECU). The 7-day mortality was 5.3% [95% confidence interval (CI): 5...... the strongest association (OR: 17, 95% CI: 14.7-19.7). MECU assistance showed an adjusted OR of 5.3 (95% CI: 4.6-6.1). CONCLUSION: The overall 7-day mortality was 5.3%, but differed in the two subgroups, with 15.4% in the MECU-assisted ambulance transfers and 3.8% in non-MECU-assisted transfers. Older age...

  3. [Emergency cesarean in a patient with Coffin-Siris syndrome].

    Science.gov (United States)

    Fornet, I; Morillas, P; López, M A; Palacio, F J; Aguilar, J M; Mesa, J L

    2007-11-01

    Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

  4. The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  6. 78 FR 79081 - Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid...

    Science.gov (United States)

    2013-12-27

    ... Conditions for Coverage CHAP Community Health Accreditation Program CMHC Community Mental Health Center COI... Pathology Services (Sec. 485.727) N. Emergency Preparedness Regulations for Community Mental Health Centers... Preparedness for Community Mental Health Centers (CMHCs)--Training and Testing (Sec. 485.920(d)) R. Conditions...

  7. Outcomes of patients with blunt chest trauma encountered at emergency department and possible risk factors affecting mortality

    Directory of Open Access Journals (Sweden)

    Yuan-Ming Tsai

    2017-01-01

    Full Text Available Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries who underwent thoracic computed tomography on arrival in the emergency department (January 2010–December 2013. Patients with brain injuries were excluded from the study. The prognostic values of age, sex, trauma type, injury severity score, revised trauma score (RTS, ventilator requirement, days in Intensive Care Unit (ICU, associated thoracic injury, and laboratory examinations (including arterial blood gas [ABG] were evaluated. Results: Fifteen of 30 analyzed patients died during their ICU stays; accordingly, we classified patients as survivors and nonsurvivors. These groups differed significantly regarding the RTS (P = 0.002, mechanical ventilation requirement (P = 0.007, total stay length (P = 0.009, and the presence of hemothorax (P = 0.030. However, no significant differences in the pneumothorax, rib fractures, and blood tests (including ABG analysis were observed between the groups. Conclusion: Among hospitalized trauma patients with blunt thoracic injuries, RTS, mechanical ventilation requirement, and hemothorax were identified as risk factors for mortality. Patients with hemothorax should receive multidisciplinary care and be monitored closely to improve survival.

  8. Syncope in pediatric patients: a practical approach to differential diagnosis and management in the emergency department [digest].

    Science.gov (United States)

    Fant, Colleen; Cohen, Ari; Vazquez, Michelle N

    2017-04-22

    Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

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

    Directory of Open Access Journals (Sweden)

    Kara H

    2013-12-01

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

  10. Patient safety climate strength: a concept that requires more attention

    Science.gov (United States)

    Ginsburg, Liane; Gilin Oore, Debra

    2016-01-01

    Background When patient safety climate (PSC) surveys are used in healthcare, reporting typically focuses on PSC level (mean or per cent positive scores). This paper explores how an additional focus on PSC strength can enhance the utility of PSC survey data. Setting and participants 442 care providers from 24 emergency departments (EDs) across Canada. Methods We use anonymised data from the Can-PSCS PSC instrument collected in 2011 as part of the Qmentum accreditation programme. We examine differences in climate strength across EDs using the Rwg(j) and intraclass correlation coefficients measures of inter-rater agreement. Results Across the six survey dimensions, median Rwg(j) was sufficiently high to support shared climate perceptions (0.64–0.83), but varied widely across the 24 ED units. We provide an illustrative example showing vastly different climate strength (Rwg(j) range=0.17–0.86) for units with an equivalent level of PSC (eg, climate mean score=3). Conclusions Most PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of patient safety. PMID:26453636

  11. A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers.

    Science.gov (United States)

    Simpson, Grant G; Hahn, Hallie R; Powel, Alex A; Leverence, Robert R; Morris, Linda A; Thompson, Lara G; Zumberg, Marc S; Borde, Deepa J; Tyndall, Joseph A; Shuster, Jonathan J; Yealy, Donald M; Allen, Brandon R

    2017-04-01

    A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily. We evaluated the effects of a single-site interventional study targeted at a population of adult sickle-cell disease super-utilizers using a pre- and post-implementation design. The pre-intervention period was 06/01/13 to 12/31/13 (seven months) and the post-intervention period was 01/01/14 to 02/28/15 (14 months). Our approach included patient-specific best practice advisories (BPA); an ED management protocol; and formation of a "medical home" for these patients. For 10 subjects targeted initially we developed and implemented coordinated care plans; after deployment, we observed a tendency toward reduction in ED and inpatient utilization across all measured indices. Between the annualized pre- and post-implementation periods we found the following: ED visits decreased by 16.5 visits/pt-yr (95% confidence interval [CI] [-1.32-34.2]); ED length of state (LOS) decreased by 115.3 hours/pt-yr (95% CI [-82.9-313.5]); in-patient admissions decreased by 4.20 admissions/pt-yr (95% CI [-1.73-10.1]); in-patient LOS decreased by 35.8 hours/pt-yr (95% CI [-74.9-146.7]); and visits where the patient left before treatment were reduced by an annualized total of 13.7 visits. We observed no patient mortality in our 10 subjects, and no patient required admission to the intensive care unit 72 hours following discharge. This effort suggests that a targeted approach is both feasible and potentially effective, laying a foundation for broader study.

  12. Factors associated with the difficulty in hospital acceptance among elderly emergency patients: A population-based study in Osaka City, Japan.

    Science.gov (United States)

    Matsuyama, Tasuku; Kitamura, Tetsuhisa; Katayama, Yusuke; Kiyohara, Kosuke; Hayashida, Sumito; Kawamura, Takashi; Iwami, Taku; Ohta, Bon

    2017-12-01

    We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients. We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on-scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis. During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls (R 2  = 0.774). In the multivariable analysis, older age (P for trend emergency-related symptoms and difficulty in hospital acceptance among elderly patients with symptoms of internal disease (AOR 1.71, 95% CI 1.53-1.91). In Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; 17: 2441-2448. © 2017 Japan Geriatrics Society.

  13. Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data.

    Science.gov (United States)

    Abel, Gary A; Mendonca, Silvia C; McPhail, Sean; Zhou, Yin; Elliss-Brookes, Lucy; Lyratzopoulos, Georgios

    2017-06-01

    Emergency diagnosis of cancer is common and aetiologically complex. The proportion of emergency presenters who have consulted previously with relevant symptoms is uncertain. To examine how many patients with cancer, who were diagnosed as emergencies, have had previous primary care consultations with relevant symptoms; and among those, to examine how many had multiple consultations. Secondary analysis of patient survey data from the 2010 English Cancer Patient Experience Survey (CPES), previously linked to population-based data on diagnostic route. For emergency presenters with 18 different cancers, associations were examined for two outcomes (prior GP consultation status; and 'three or more consultations' among prior consultees) using logistic regression. Among 4647 emergency presenters, 1349 (29%) reported no prior consultations, being more common in males (32% versus 25% in females, P <0.001), older (44% in ≥85 versus 30% in 65-74-year-olds, P <0.001), and the most deprived (35% versus 25% least deprived, P = 0.001) patients; and highest/lowest for patients with brain cancer (46%) and mesothelioma (13%), respectively ( P <0.001 for overall variation by cancer site). Among 3298 emergency presenters with prior consultations, 1356 (41%) had three or more consultations, which were more likely in females ( P <0.001), younger ( P <0.001), and non-white patients ( P = 0.017) and those with multiple myeloma, and least likely for patients with leukaemia ( P <0.001). Contrary to suggestions that emergency presentations represent missed diagnoses, about one-third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one-third report multiple (three or more) consultations, which are more likely in 'harder-to-suspect' groups. © British Journal of General Practice 2017.

  14. Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.

    Science.gov (United States)

    Gary, Tiffany L; Maiese, Eric M; Batts-Turner, Marian; Wang, Nae-Yuh; Brancati, Fredrick L

    2005-12-01

    The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.

  15. [Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

    Science.gov (United States)

    Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

    2017-01-01

    Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

  16. [Clinical analysis of patients with tuberculosis admitted on an emergency cases].

    Science.gov (United States)

    Okada, Toru; Shibuya, Yasuhiro; Saito, Hitoshi; Enomoto, Tatsuji; Nakamura, Seiichi

    2008-08-01

    A retrospective study was made of 75 patients with tuberculosis and tuberculous pleurisy who received medical care in our hospital from 2002 through 2006. Of the 75 patients, 9 were admitted as tertiary emergency cases, and 12 patients were admitted by ambulance as secondary emergency cases. We studied the reason for their emergency medical admission, and the process of diagnosing 21 patients as tuberculosis. In some cases, the reasons for emergency admission were cardiorespiratory arrest, loss of consciousness, and injury resulting from a traffic accident, not common symptoms of tuberculosis such as dyspnea, hemoptysis and bloody sputum. Chest radiographic findings of most patients showed tuberculosis, and other cases were likely to be diagnosed as tuberculosis from their medical history or back-ground such as being homeless, previous tuberculosis, and receiving for therapy of tuberculosis. It was not so difficult to diagnose our cases as tuberculosis, nevertheless we may have an unconscious patient with normal chest radiograph. These data suggest that any patients visiting the emergency room may possibly have tuberculosis even if they are without respiratory symptoms.

  17. Psychiatric patient disposition agreement between the emergency physician and the psychiatry consultant.

    Science.gov (United States)

    Chakravarthy, Bharath; Menchine, Michael; Thompson, Daniel E; Rajeev, Sindhya; Santos, Barbara-Jean

    2013-01-01

    Mental illness is prevalent, disabling, and costly. Emergency department (ED) visits for mental health-related reasons are on the increase. Determine the level of agreement between emergency physicians and psychiatrists regarding psychiatric patient disposition. We conducted a prospective, observational study at a private university hospital ED from October 2008-April 2009 using a convenience sample of patients of all ages with psychiatric complaints who received formal psychiatric consultation during their ED visit. The emergency physician completed a data sheet prior to psychiatric consultation, assessing the likelihood of admission for psychiatric evaluation. We evaluated the positive predictive value (PPV) and negative predictive value (NPV) of the emergency physician admission decision for all patients before psychiatric consultation, compared with the patients' actual disposition as determined by the consulting psychiatrist. The study captured 230 subjects, 53% of whom were suicidal patients. 74% of patients were eventually admitted. The emergency physician decision to admit for inpatient psychiatric evaluation had a PPV of 87.3% (CI 81.4-91.9%) and an NPV of 66.7% (CI 52.9-78.6%) compared to the psychiatrist decision for the total sample, and a PPV of 90% (CI 82.4-95.1%) and an NPV of 69.6% (CI 47.1-86.8%) for suicidal patients. Additionally, the κ score, a measure of agreement between emergency physician disposition decision and psychiatrist disposition decision, was 0.530 (Cl 0.404-0.656). 95% of patients with an ED assessment of "definitely admit" were eventually admitted by the psychiatrist. Emergency physician disposition has a high PPV (87.3%) and a moderate NPV (66.7%) compared to psychiatrist disposition.

  18. Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Baber, Chris

    2015-06-01

    Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Effects of seasonal smog on asthma and COPD exacerbations requiring emergency visits in Chiang Mai, Thailand.

    Science.gov (United States)

    Pothirat, Chaicharn; Tosukhowong, Apiwat; Chaiwong, Warawut; Liwsrisakun, Chalerm; Inchai, Juthamas

    2016-12-01

    Seasonal smog produces particulate matters that are less than 10 microns in diameter (PM₁₀), which are known to have several impacts on the respiratory system. This study was to determine the association of an increased PM10 level due to seasonal smog in Chiang Mai and emergency visits for asthma and chronic obstructive pulmonary disease (COPD) exacerbations. A retrospective cross-sectional study was conducted between the months of January and March from 2006 until 2009. The association of an increased PM₁₀ level and the daily number of asthma and COPD exacerbations were analyzed using a generalized linear model; a Poisson regression model was fit to the number of daily emergency visits using predictor variables: lags of PM10, day of the week, and time. There were a total of 917 emergency visits for acute exacerbations of asthma and COPD, with a median of 2 visits per day (range 0-10). The median PM₁₀ level during the same interval was 64.5 microgram per cubic meter (μg/m3) (16-304). For every 10 μg/m3 rise in PM10 concentration, there was a lag time of 6 days for asthma exacerbations [Adjusted relative risk (RR)=1.020; 95% confident interval (CI), 1.001-1.040; (p=0.014)], 7 days for COPD exacerbations [RR=1.030; 95%CI, 1.010-1.050 (p=0.024)] and 7 days for all exacerbations [RR=1.030 95%CI, 1.010-1.040 (p<0.001)]. This study confirms the effect of increasing PM₁₀ concentrations from seasonal smog on asthma and COPD exacerbations. However, there was an approximately 1 week lag time between the elevated PM₁₀ levels and time to emergency visits due to disease exacerbation.

  20. Review and assessment of package requirements (yellowcake) and emergency response to transportation accidents

    International Nuclear Information System (INIS)

    1978-10-01

    As a consequence of an accident involving a truck shipment of yellowcake, a joint NRC--DOT study was undertaken to review and assess the regulations and practices related to package integrity and to emergency response to transportation accidents involving low specific activity radioactive materials. Recommendations are made regarding the responsibilities of state and local agencies, carriers, and shippers, and the DOT and NRC regulations

  1. Requirements and Challenges of Location-Based Access Control in Healthcare Emergency Response

    DEFF Research Database (Denmark)

    Vicente, Carmen Ruiz; Kirkpatrick, Michael; Ghinita, Gabriel

    2009-01-01

    Recent advances in positioning and tracking technologies have led to the emergence of novel location-based applications that allow participants to access information relevant to their spatio-temporal context. Traditional access control models, such as role-based access control (RBAC), are not suf...... to such settings. We overview the main technical issues to be addressed, and we describe the architecture for policy decision and enforcement points....

  2. Evaluation of New-Onset Diabetes in Patients Presenting Emergency Service with a Diabetic Ketoacidosis Attack

    Directory of Open Access Journals (Sweden)

    Yavuz Yiğit

    2013-12-01

    Full Text Available Aim: The aim of this study was to investigate the rate of new-onset diabetes mellitus (DM in patients presenting to our emergency department with diabetic ketoacidosis. Methods: We retrospectively evaluated hospital records of patients who presented to the Emergency Department at Istanbul Goztepe Research and Training Hospital between 01 April 2009 and 01 April 2011 and were diagnosed with diabetic ketoacidosis. 57 patients having complete clinical data were included in the study. Results: 45.6%of patients had type 1 DM, 33.3%- type 2 DM, and 21%of them were with new-onset DM. No statistically significant difference was found between type 1 DM, type 2 DM and new-onset DM patients with respect to arterial blood pH and HCO3 levels and serum sodium, potassium and plasma glucose levels at presentation as well as time of presentation (p>0.05, while HbA1c levels showed statistically significant difference in new-onset DM patients. Conclusion: No statistically significant difference was found between types of DM in patients diagnosed with diabetic ketoacidosis except for precipitating factors, age and HbA1c. Detecting high blood glucose levels in patients presenting to emergency room for reasons other than DM is not a rare condition. Cautious evaluation and recognition of these patients in emergency room for the possibility of undiagnosed DM is important for prevention of future diabetic ketoacidosis episodes. (The Medical Bulletin of Haseki 2013; 51: 168-72

  3. Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

    Science.gov (United States)

    Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

    2014-01-01

    The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

  4. Early predictors of narcotics-dependent patients in the emergency department

    Directory of Open Access Journals (Sweden)

    Wei-Che Lee

    2013-06-01

    Full Text Available It is not unusual that narcotics-dependent patients fulfill their medical requirements in the emergency department (ED. The behavior of these patients varies, and their manifestations and predictors are still not fully studied. We performed this retrospective study by prospectively collecting data on patients with suspected drug dependence who were undiagnosed at first and then treated for some kind of reported pain at the ED. Patients who were confirmed to have narcotics dependence were compared with control patients in a ratio of 1:3 matching for age, gender, disease, and clinical diagnoses. From January 2006 to October 2009, 26 of 223 patients treated for pain were found to be drug dependent (12 males and 14 females. The average dose of narcotics used was higher than the control group [3.23 ± 1.14 vs. 1.12 ± 0.36, p < 0.001, confidence interval (CI: 1.648–2.583]. Numbers of patients making unscheduled returns to the ED within 24 hours were significant [24/26 vs. 8/78, p ≤ 0.001, odds ratio (OR 105.00, 95% CI 20.834–529.175]. In addition, patients showing aggressive attitudes were significant (17/26 vs. 2/78, p < 0.001, OR 71.78, 95% CI 14.206–362.663. In the case group, six of them told the physician that they were allergic to medicines other than the particular one they wanted, and three of the six presented injuries that were reported to be in the same (or repeated place for unscheduled returns, which were not found in the control group. In this study, some behaviors were commonly observed in the at-risk group. These patients were prone to manifest some types of symptoms and behaviors, such as uncontrolled pain with three doses of analgesics, aggressive attitude, returning to the ED within 24 hours with the complaint of the same severe pain, repeating the same injury, claiming allergy to other analgesics, and asking for certain analgesics. All these behaviors should alert the physician to suspect a drug-seeking problem.

  5. Understanding inappropriate hospital admissions of patients presenting to the Emergency Department.

    Directory of Open Access Journals (Sweden)

    Roberta Siliquini

    2005-06-01

    Full Text Available

    Objectives. To identify 1 the characteristics of patients receiving non acute (inappropriate care and 2 the variables associated to inappropriate hospital use, in order to 3 estimate the relevance of the problem and to 4 focus future concurrent reviews and efforts to allocate patients to alternative health care settings.

    Design. A prospective review of a random sample of adult patients who presented to the Emergency Department of the Molinette Hospital. Patients were assessed at admission and on day 3, 5and 8 using the Appropriateness Evaluation Protocol (Italian validated version. Patients: 490 overall; 312 (64 % medical and 178 (36 % surgical.

    Outcome measures. Acute (appropriate and non acute (inappropriate admissions, Major Disease Category, costs, mean weights of Diagnosis Related Groups, and length of stay (days.

    Results. The proportion of patients requiring acute care declined rapidly from presentation (84.5% to the fifth day of admission (60.9%. Patients admitted during weekends showed a higher rate of inappropriate stay on day 5 (P=0.04. The proportion of inappropriate admissions was higher for medical rather than surgical patients (P=0.07 at presentation and at day 5 (P < 0.01. Traditional social-demographic variables were not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriate admission at presentation was significantly higher for minor illnesses and disturbances (P=0.03.

    Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01, lower mean DRG weight (P < 0.01 and shorter length of stay (P=0.05 for medical but not for surgical admissions.

    Conclusions. Traditional epidemiological indicators are inadequate to target prospective concurrent reviews. Qualitative studies focusing on patient physician dialogue in different situations and contexts could

  6. Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients.

    Science.gov (United States)

    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

  7. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  8. New source terms and the implications for emergency planning requirements at nuclear power plants in the United State

    International Nuclear Information System (INIS)

    Kaiser, G.D.; Cheok, M.C.

    1987-01-01

    This paper begins with a brief review of current approaches to source term driven changes to NRC emergency planning requirements and addresses significant differences between them. Approaches by IDCOR and EPRI, industry submittals to NRC and alternative risk-based evaluations have been considered. Important issues are discussed, such as the role of Protective Action Guides in determining the radius of the emergency planning zone (EPZ). The significance of current trends towards the prediction of longer warning times and longer durations of release in new source terms is assessed. These trends may help to relax the current notification time requirements. Finally, the implications of apparent support in the regulations for a threshold in warning time beyond which ad hoc protective measures are adequate is discussed

  9. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients.

    Science.gov (United States)

    Polak, Rani; Phillips, Edward M; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S; Burg, Tracey; Eisenberg, David

    2016-01-01

    Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

  10. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients

    Science.gov (United States)

    Phillips, Edward M.; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S.; Burg, Tracey; Eisenberg, David

    2016-01-01

    Background: Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. Objective: The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. Methods: During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. Results: All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. Conclusions: There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges. PMID:26937315

  11. Are patient specific meshes required for EIT head imaging?

    Science.gov (United States)

    Jehl, Markus; Aristovich, Kirill; Faulkner, Mayo; Holder, David

    2016-06-01

    Head imaging with electrical impedance tomography (EIT) is usually done with time-differential measurements, to reduce time-invariant modelling errors. Previous research suggested that more accurate head models improved image quality, but no thorough analysis has been done on the required accuracy. We propose a novel pipeline for creation of precise head meshes from magnetic resonance imaging and computed tomography scans, which was applied to four different heads. Voltages were simulated on all four heads for perturbations of different magnitude, haemorrhage and ischaemia, in five different positions and for three levels of instrumentation noise. Statistical analysis showed that reconstructions on the correct mesh were on average 25% better than on the other meshes. However, the stroke detection rates were not improved. We conclude that a generic head mesh is sufficient for monitoring patients for secondary strokes following head trauma.

  12. Emergency TIPS in a Child-Pugh B patient

    DEFF Research Database (Denmark)

    Trebicka, Jonel

    2017-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using...... translocation. Both these processes mediate an impaired immunological and hemodynamic response, thereby facilitating the development of acute-on-chronic liver failure (ACLF) and/or death. Similarly, in patients with refractory ascites, TIPS should be used early in treatment to prevent acute kidney injury (AKI...

  13. Patients without borders: the emergence of medical tourism.

    Science.gov (United States)

    Ramírez de Arellano, Annette B

    2007-01-01

    A growing number of patients from the United States and other developed countries are traveling abroad with the express purpose of obtaining health care, including elective surgery and long-term care. This trend is not innocuous. It can lead developing countries to emphasize technology-intensive tertiary care for foreigners at the expense of basic health care for their citizens. Moreover, it can exacerbate the brain drain from the public to the private sector. The examples of Thailand and India suggest the distorting effects of this trend and raise questions of social equity in the distribution of scarce resources.

  14. Long-Term Mortality of Emergency Medical Services Patients

    DEFF Research Database (Denmark)

    Bøtker, Morten T; Terkelsen, Christian J; Sørensen, Jan Nørtved

    2017-01-01

    , and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients......). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index. RESULTS: Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic...... symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28...

  15. Emerging uses of patient generated health data in clinical research.

    Science.gov (United States)

    Wood, William A; Bennett, Antonia V; Basch, Ethan

    2015-05-01

    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  16. What Drives Emergency Department Patient Satisfaction? An Empirical Test using Structural Equation Modeling

    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...

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  18. Level of Agitation of Psychiatric Patients Presenting to an Emergency Department

    OpenAIRE

    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.

  19. Introduction of new guidelines for emergency patients: motivational counselling among smokers

    DEFF Research Database (Denmark)

    Backer, Vibeke; Nelbom, Bente Munkholm; Duus, Benn Rønnow

    2007-01-01

    Smoking is the most important risk factor for morbidity and mortality in hospital patients. Patient contact with the healthcare system should include smoking cessation counselling. Emergency admissions are seldom given this opportunity. Objective: The aim of the study was to illustrate the implem...

  20. Introduction of new guidelines for emergency patients: motivational counselling among smokers

    DEFF Research Database (Denmark)

    Backer, Vibeke; Nelbom, Bente Munkholm; Duus, Benn Rønnow

    2007-01-01

    Smoking is the most important risk factor for morbidity and mortality in hospital patients. Patient contact with the healthcare system should include smoking cessation counselling. Emergency admissions are seldom given this opportunity. Objective: The aim of the study was to illustrate the implem...... the implementation of motivational counselling in a department of acute surgery....

  1. Prevalence and relief of pain in trauma patients in Emergency Medical Services

    NARCIS (Netherlands)

    Lisette Schoonhoven; T. Meijs; Sivera Berben; A. van Vugt; P. van Grunsven

    2011-01-01

    The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. The retrospective document study included adult and alert trauma patients. Data

  2. Emergence of a phase transition for the required amount of storage in highly renewable electricity systems

    DEFF Research Database (Denmark)

    Jensen, Tue Vissing; Greiner, Martin

    2014-01-01

    -up of the required amount of storage, with renewable penetration being the control parameter and average relative storage filling level being the order parameter. A singularity appears for the required storage energy capacity at a renewable penetration determined by the parameters of the storage. For an ideal...... storage with no roundtrip losses the transition occurs at 100% renewable penetration. Moreover, the required storage energy capacity is strongly enhanced by temporal correlations on the synoptic weather time scale. A Markov process is proposed, which reproduces these findings....

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

    Directory of Open Access Journals (Sweden)

    Abdulkadir Akturk

    2013-08-01

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

  4. Behavioral Emergency Response Team: Implementation Improves Patient Safety, Staff Safety, and Staff Collaboration.

    Science.gov (United States)

    Zicko, Cdr Jennifer M; Schroeder, Lcdr Rebecca A; Byers, Cdr William S; Taylor, Lt Adam M; Spence, Cdr Dennis L

    2017-10-01

    Staff members working on our nonmental health (non-MH) units (i.e., medical-surgical [MS] units) were not educated in recognizing or deescalating behavioral emergencies. Published evidence suggests a behavioral emergency response team (BERT) composed of MH experts who assist with deescalating behavioral emergencies may be beneficial in these situations. Therefore, we sought to implement a BERT on the inpatient non-MH units at our military treatment facility. The objectives of this evidence-based practice process improvement project were to determine how implementation of a BERT affects staff and patient safety and to examine nursing staffs' level of knowledge, confidence, and support in caring for psychiatric patients and patients exhibiting behavioral emergencies. A BERT was piloted on one MS unit for 5 months and expanded to two additional units for 3 months. Pre- and postimplementation staff surveys were conducted, and the number of staff assaults and injuries, restraint usage, and security intervention were compared. The BERT responded to 17 behavioral emergencies. The number of assaults decreased from 10 (pre) to 1 (post); security intervention decreased from 14 to 1; and restraint use decreased from 8 to 1. MS staffs' level of BERT knowledge and rating of support between MH staff and their staff significantly increased. Both MS and MH nurses rated the BERT as supportive and effective. A BERT can assist with deescalating behavioral emergencies, and improve staff collaboration and patient and staff safety. © 2017 Sigma Theta Tau International.

  5. Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel.

    Science.gov (United States)

    Plint, Amy C; Stang, Antonia S; Calder, Lisa A

    2015-01-01

    Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for

  6. Patient satisfaction in out-of-hospital emergency care: a multicentre survey.

    Science.gov (United States)

    Neumayr, Agnes; Gnirke, André; Schaeuble, Joerg C; Ganter, Michael T; Sparr, Harald; Zoll, Adolf; Schinnerl, Adolf; Nuebling, Matthias; Heidegger, Thomas; Baubin, Michael

    2016-10-01

    There is only limited information on patient satisfaction with emergency medical services (EMS). The aim of this multicentre survey was to evaluate patient satisfaction in five out-of-hospital physician-based EMS in Austria and Switzerland. The psychometrically tested and standardized questionnaire 'patient satisfaction in out-of-hospital emergency care' was used for this survey. The recruitment of the patients was carried out on the basis of inclusion and exclusion criteria. All questionnaires were sent together with an invitation letter and a prepaid return envelope, followed by a reminder 2 weeks later. The descriptive statistical analysis was carried out by an external organization to maintain anonymity. The response rate of all EMS was 46.7%. High satisfaction rates were achieved for the four quality scales 'emergency call, emergency treatment, transport and hospital admission'. A significant difference was found between the Swiss and the Austrian dispatch centres in the judgement of the call takers' social skills. Patient satisfaction with the emergency treatment, for example, reduction of pain, was high in all EMS, independent of whether the EMS is physician (Austria) or physician and emergency medical assistant based (Switzerland). Lowest satisfaction rates were found for items of social skills. Patient satisfaction in out-of-hospital physician-based EMS is generally high. There is room for improvement in areas such as the social skills of dispatchers and EMS-team members and the comfort of the patients during transport. A checklist should be developed for basic articles that patients should take along to hospital and for questions on responsibilities for children, dependent people or pets.

  7. A systematic review of patient tracking systems for use in the pediatric emergency department.

    Science.gov (United States)

    Dobson, Ian; Doan, Quynh; Hung, Geoffrey

    2013-01-01

    Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security. To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety. Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool. Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws. Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers.

    Science.gov (United States)

    Kreinest, Michael; Gliwitzky, Bernhard; Schüler, Svenja; Grützner, Paul A; Münzberg, Matthias

    2016-05-14

    In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel. A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol. Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E

  9. EM Talk: communication skills training for emergency medicine patients with serious illness.

    Science.gov (United States)

    Grudzen, Corita R; Emlet, Lillian L; Kuntz, Joanne; Shreves, Ashley; Zimny, Erin; Gang, Maureen; Schaulis, Monique; Schmidt, Scott; Isaacs, Eric; Arnold, Robert

    2016-06-01

    The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care. To expand communication skills training to emergency medicine, we developed a programme to give emergency medicine physicians the ability to empathically deliver serious news and to talk about goals of care. We have built on lessons from prior studies to design an intervention employing the most effective pedagogical techniques, including the use of simulated patients/families, role-playing and small group learning with constructive feedback from master clinicians. Here, we describe our evidence-based communication skills training course EM Talk using simulation, reflective feedback and deliberate practice. 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/

  10. Characterization of patients aged 45 or under admitted with hypertensive emergencies in the Hospital do Prenda.

    Science.gov (United States)

    García, Geovedy Martínez; Miúdo, Venâncio; Manuel Lopes, Conceição da Graça Alves; Vassuelela Gomes, Juliana

    2014-01-01

    The incidence and prevalence of hypertensive emergency have been little addressed in the literature. However, over the last decade increasing numbers of young patients with different forms of hypertensive crisis have been observed in emergency departments. We performed this study to ascertain the clinical and epidemiological characteristics of patients aged ≤ 45 years admitted with a diagnosis of hypertensive emergency. We conducted an observational, descriptive, cross-sectional prospective study of 123 patients hospitalized for hypertensive emergency in the Hospital do Prenda, Luanda, between May 2011 and June 2012. Mean age was 36.62 ± 5.49 years, and most were male (52.85%). The main risk factor was hypertension (65.9%), with 17.3% complying with therapy. The most frequent forms of presentation were hypertensive encephalopathy and hemorrhagic stroke (9.8% and 82.1%, respectively). The main drugs used were diuretics, angiotensin-converting enzyme inhibitors and calcium channel blockers. Mortality during hospitalization was 25.2% (31 patients), hemorrhagic stroke being the most common cause. There was a significant association between age and in-hospital mortality. Of patients admitted with hypertensive emergency, 30.1% were aged ≤ 45 years. Hemorrhagic stroke was the most common presentation. There was a significant relationship between mode of presentation, age and in-hospital mortality. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

    Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year's worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED "carousel". Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Emerging potential treatments: new hope for idiopathic pulmonary fibrosis patients?

    Directory of Open Access Journals (Sweden)

    U. Costabel

    2011-09-01

    Full Text Available Currently, there are no approved pharmacological treatments for the management of patients with idiopathic pulmonary fibrosis (IPF in the USA or Europe. Pirfenidone is an orally bio-available small molecule that exhibits antifibrotic and anti-inflammatory properties in a variety of in vitro and animal models. Pirfenidone has been evaluated in four randomised, double-blind, placebo-controlled clinical trials conducted in Japan, North America and Europe. The totality of the data from these trials indicates that pirfenidone is able to reduce the rate of decline in lung function, measured as change in per cent predicted forced vital capacity (FVC or vital capacity. There was also an effect on secondary end-points of progression free survival, categorical change in per cent predicted FVC, and the 6-min walk test. A recent meta-analysis of the three phase III studies in IPF demonstrated that pirfenidone significantly reduced the risk of disease progression by 30%. The efficacy of pirfenidone is associated with an acceptable tolerability and safety profile.

  13. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Brabrand, Mikkel; Lassen, Annmarie Touborg

    2014-01-01

    vital signs at arrival to a medical emergency department (MED). DESIGN AND SETTING: Single-centre, retrospective cohort study of all patients admitted to the MED from September 2010-August 2011. SUBJECTS: Patients were included when their vital signs (systolic blood pressure, pulse rate, respiratory.......2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10). CONCLUSIONS: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open...... general ED. Thirty-day mortality among patients with deterioration was four times higher than among non-deteriorating patients. Further research is needed to determine whether intensified monitoring of vital signs can help to prevent deterioration or mortality among medical emergency patients....

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

    Science.gov (United States)

    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.

  15. Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    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.

  16. Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.

    Science.gov (United States)

    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.

  17. Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn's Disease Presenting to the Emergency Department.

    Science.gov (United States)

    Jung, Yoon Suk; Park, Dong Il; Hong, Sung Noh; Kim, Eun Ran; Kim, Young Ho; Cheon, Jae Hee; Eun, Chang Soo; Han, Dong Soo; Lee, Chang Kyun; Kim, Jae Hak; Huh, Kyu Chan; Yoon, Soon Man; Song, Hyun Joo; Shin, Jeong Eun; Jeon, Seong Ran

    2015-04-01

    Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P 100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.

  18. The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study

    Science.gov (United States)

    Sabin, Allison V; Levin, Pamela F

    2015-10-22

    The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

  19. Neuroimaging of Patients with Headache in the Emergency Room: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    ibrahim Burak Atci

    2015-03-01

    Conclusion: In the emergency department during evaluation of headache, that should be done first is the exclusion of headaches which is caused by non beningn intracranial patologies. Therefore, from the entrance of the patients evaluated in the emergency room, it is important that they must be directed to rapid diagnosis and treatment with considering the red alert findings. [Cukurova Med J 2015; 40(1.000: 86-90

  20. [A new artificial intelligence tool for assessing symptoms in patients seeking emergency department care: the Mediktor application].

    Science.gov (United States)

    Moreno Barriga, Elvira; Pueyo Ferrer, Irene; Sánchez Sánchez, Miquel; Martín Baranera, Montserrat; Masip Utset, Josep

    2017-01-01

    To analyze agreement between diagnoses issued by the Mediktor application and those of an attending physician, and to evaluate the usefulness of this application in patients who seek emergency care. Prospective observational study in a tertiary care university hospital emergency department. Patients with medical problems and surgical conditions (surgery and injuries) who did not require immediate emergency care responded to the Mediktor questions on a portable computer tablet. The software analyzed the answers and provided a list of 10 possible preliminary diagnoses in order of likelihood. The patient and the attending physician were blinded to the list to so that the usual care process would not be altered. The level of agreement between the physician's diagnosis and the Mediktor diagnosis was analyzed. A total of 1015 patients were included; 622 cases were considered valid for study. Cases were excluded if the patients did not meet the inclusion criteria, they did not have a discharge diagnosis, they had a final diagnosis expressed as a symptom or their final diagnosis was not included in the Mediktor database. The physician's diagnosis (the gold standard) coincided with one of the 10 MEDIKTOR diagnoses in 91.3% of the cases, with one of the first 3 diagnoses in 75.4%, and with the first diagnosis in 42.9%. Sensitivity was over 92% and specificity over 91% in the majority of common diagnostic groups; the κ statistic ranged from 0.24 to 0.98. The Mediktor application is a reliable diagnostic aid for the most prevalent problems treated in a hospital emergency department. The general public finds it easy to use.

  1. 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...

  2. The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room

    DEFF Research Database (Denmark)

    Mygind, Anna; Nørredam, Marie Louise; Nielsen, Anette S

    2008-01-01

    AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers...... at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate...... satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less...

  3. Pulmonary Arteriovenous Malformation (AVM Causing Tension Hemothorax in a Pregnant Woman Requiring Emergent Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Nidhi Sood

    2011-01-01

    Full Text Available Pulmonary arteriovenous malformations (PAVMs, although most commonly congenital, are usually detected later in life. We present a case of a 25-year-old woman with no previous history of AVM or telangiectasia, who presented with life-threatening hypoxia, hypotension, and pleuritic chest pain in 36th week of gestation. Chest tube placement revealed 4 liters of blood. Patient was subsequently found to have bleeding pulmonary AVM as the source of hemothorax. Successful embolisation of the bleeding vessel followed by thoracoscopic evacuation of the organized clot relieved the hypoxia. Further screening for AVM revealed large splenic AVM for which patient underwent splenectomy in the coming months.

  4. A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

    Directory of Open Access Journals (Sweden)

    Gultekin Gulbahar

    2015-01-01

    Full Text Available Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

  5. Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count.

    Science.gov (United States)

    Hess, Erik P; Grudzen, Corita R; Thomson, Richard; Raja, Ali S; Carpenter, Christopher R

    2015-07-01

    Shared decision-making (SDM), a collaborative process in which patients and providers make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. Despite these challenges, in a recent survey emergency physicians reported there to be more than one reasonable management option for over 50% of their patients and that they take an SDM approach in 58% of such patients. SDM has also been selected as the topic on which to develop a future research agenda at the 2016 Academic Emergency Medicine consensus conference, "Shared Decision-making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" (http://www.saem.org/annual-meeting/education/2016-aem-consensus-conference). In this paper the authors describe the conceptual model of SDM as originally conceived by Charles and Gafni and highlight aspects of the model relevant to the practice of emergency medicine. In addition, through the use of vignettes from the authors' clinical practices, the applicability of SDM to contemporary EM practice is illustrated and the ethical and pragmatic implications of taking an SDM approach are explored. It is hoped that this document will be read in advance of the 2016 Academic Emergency Medicine consensus conference, to facilitate group discussions at the conference. © 2015 by the Society for Academic Emergency Medicine.

  6. 3D Geo-Information requirements for disaster and emergency management

    NARCIS (Netherlands)

    Demir Ozbek, E.; Zlatanova, S.; Ates Aydar, S.; Yomralioglu, T

    2016-01-01

    A conceptual approach is proposed to define 3D geo-information requirement for different types of disasters. This approach includes components such as Disaster Type-Sector-Actor-Process-Activity-Task-Data. According to disaster types processes, activities, tasks, sectors, and responsible and

  7. 42 CFR 3.210 - Required disclosure of patient safety work product to the Secretary.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Required disclosure of patient safety work product... HUMAN SERVICES GENERAL PROVISIONS PATIENT SAFETY ORGANIZATIONS AND PATIENT SAFETY WORK PRODUCT Confidentiality and Privilege Protections of Patient Safety Work Product § 3.210 Required disclosure of patient...

  8. Hypobaric spinal anesthesia in the operative management of orthopedic emergencies in geriatric patients.

    Science.gov (United States)

    Sidi, A; Pollak, D; Floman, Y; Davidson, J T

    1984-07-01

    Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.

  9. Evaluation of Patients Visiting the Dermatology Emergency Unit of a University Dermatology Hospital in Tehran, Iran.

    Science.gov (United States)

    Abedini, Robabeh; Matinfar, Amin; Sasani, Pardis; Salehi, Anahita; Daneshpazhooh, Maryam

    2017-11-01

    Published studies on dermatological emergencies are limited in the literature. To our knowledge, no study has previously explored this subject in Iran. Our aim was to ascertain the characteristics of patients visiting the dermatologic emergency (DE) unit of a university skin hospital in Tehran, Iran. We studied the files of all the patients seen in the DE unit over a 3-month period, collecting data on age, sex, referral mode, duration of consultation, status (true emergency or non-emergency), and diagnosis. A total of 2539 patients were evaluated; 53% of them were female. Infection and infestation (41.9%), urticaria (16.7%), and dermatitis (13.2%) were the most prevalent entities. Almost 1% of the patients were referred by another physician and psoriasis was their most frequent diagnosis. Almost 2.6% of the patients were hospitalized; psoriasis was once again the most frequent cause. The hospitalization rate was significantly higher in referred patients (Pdermatologic disorders. This data could also help in tailoring the educational curriculum for medical students more appropriately in order to increase their knowledge of the most prevalent skin disorders.

  10. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

    Directory of Open Access Journals (Sweden)

    Zimmermann Heinz

    2008-12-01

    Full Text Available Abstract Background In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. Methods This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17. After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER: Follow-up and final examination in the hospital's emergency unit. Group B (GP: Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Results Female and male patients were equally represented in both groups. The age of the patients ranged from 16 – 64 years, with a mean age of 34 years (ER and 35 years (GP. 98% (n = 98 of all patients were satisfied with their treatment, and 93% (n = 93 were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively. 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc. on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669. Conclusion Patients who first present at the ER with a lateral

  11. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

    Science.gov (United States)

    Schwab, Patrik R; Benneker, Lorin M; Eggli, Stefan; Zimmermann, Heinz; Exadaktylos, Aristomenis K

    2008-12-23

    In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a

  12. Caring for inpatient boarders in the emergency department: improving safety and patient and staff satisfaction.

    Science.gov (United States)

    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.

  13. Retrospective Evaluation of Patients Admitted to the Pediatric Emergency Department with Intoxication

    Directory of Open Access Journals (Sweden)

    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.

  14. Entrepreneurship management skills requirements in an emerging economy: A South African outlook

    Directory of Open Access Journals (Sweden)

    M. Anastacia Mamabolo

    2017-05-01

    Aim: This study’s aim was to determine skills required by South African entrepreneurs to run their businesses. Setting: Entrepreneurs who own and run businesses in South Africa. Method: A sequential exploratory mixed method research design was applied in the study. Phase I, which consisted of qualitative interviews with 15 entrepreneurs and 6 national experts, resulted in skills that were used to develop a survey instrument. A survey was conducted in Phase II on 235 entrepreneurs to confirm the skills to a larger population. Results: Confirmatory factor analysis results showed that entrepreneurs require financial management, human resource management, start-up, social and interpersonal, leadership, personality, marketing, technical and business management skills. Conclusion: The identified skills through empirical research will be instrumental in the training of entrepreneurs and as a tool to measure skills in future entrepreneurship skills research.

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

    LENUS (Irish Health Repository)

    Kidney, R

    2010-09-01

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

  16. Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity : The EQUALITY Study.

    Science.gov (United States)

    Haider, Adil H; Schneider, Eric B; Kodadek, Lisa M; Adler, Rachel R; Ranjit, Anju; Torain, Maya; Shields, Ryan Y; Snyder, Claire; Schuur, Jeremiah D; Vail, Laura; German, Danielle; Peterson, Susan; Lau, Brandyn D

    2017-06-01

    The Institute of Medicine and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown. To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. Qualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information. Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for demographic characteristics, only bisexual patients had increased odds of refusing to provide sexual

  17. Documenting the emergence of bio-ontologies: or, why researching bioinformatics requires HPSSB.

    Science.gov (United States)

    Leonelli, Sabina

    2010-01-01

    This paper reflects on the analytic challenges emerging from the study of bioinformatic tools recently created to store and disseminate biological data, such as databases, repositories, and bio-ontologies. I focus my discussion on the Gene Ontology, a term that defines three entities at once: a classification system facilitating the distribution and use of genomic data as evidence towards new insights; an expert community specialised in the curation of those data; and a scientific institution promoting the use of this tool among experimental biologists. These three dimensions of the Gene Ontology can be clearly distinguished analytically, but are tightly intertwined in practice. I suggest that this is true of all bioinformatic tools: they need to be understood simultaneously as epistemic, social, and institutional entities, since they shape the knowledge extracted from data and at the same time regulate the organisation, development, and communication of research. This viewpoint has one important implication for the methodologies used to study these tools; that is, the need to integrate historical, philosophical, and sociological approaches. I illustrate this claim through examples of misunderstandings that may result from a narrowly disciplinary study of the Gene Ontology, as I experienced them in my own research.

  18. Cognitive and motivational requirements for the emergence of cooperation in a rat social game.

    Science.gov (United States)

    Viana, Duarte S; Gordo, Isabel; Sucena, Elio; Moita, Marta A P

    2010-01-13

    Game theory and the Prisoner's Dilemma (PD) game in particular, which captures the paradox of cooperative interactions that lead to benefits but entail costs to the interacting individuals, have constituted a powerful tool in the study of the mechanisms of reciprocity. However, in non-human animals most tests of reciprocity in PD games have resulted in sustained defection strategies. As a consequence, it has been suggested that under such stringent conditions as the PD game humans alone have evolved the necessary cognitive abilities to engage in reciprocity, namely, numerical discrimination, memory and control of temporal discounting. We use an iterated PD game to test rats (Rattus norvegicus) for the presence of such cognitive abilities by manipulating the strategy of the opponent, Tit-for-Tat and Pseudo-Random, or the relative size of the temptation to defect. We found that rats shape their behaviour according to the opponent's strategy and the relative outcome resulting from cooperative or defective moves. Finally, we show that the behaviour of rats is contingent upon their motivational state (hungry versus sated). Here we show that rats understand the payoff matrix of the PD game and the strategy of the opponent. Importantly, our findings reveal that rats possess the necessary cognitive capacities for reciprocity-based cooperation to emerge in the context of a prisoner's dilemma. Finally, the validation of the rat as a model to study reciprocity-based cooperation during the PD game opens new avenues of research in experimental neuroscience.

  19. Analysis of Patient Visits and Collections After Opening a Satellite Pediatric Emergency Department.

    Science.gov (United States)

    Nichols, Katherine M; Caperell, Kerry; Cross, Keith; Duncan, Scott; Foster, Ben; Liu, Gil; Pritchard, Hank; Southard, Gary; Shinabery, Ben; Sutton, Brad; Kim, In K

    2018-04-01

    Satellite pediatric emergency departments (PEDs) have emerged as a strategy to increase patient capacity. We sought to determine the impact on patient visits, physician fee collections, and value of emergency department (ED) time at the primary PED after opening a nearby satellite PED. We also illustrate the spatial distribution of patient demographics and overlapping catchment areas for the primary and satellite PEDs using geographical information system. A structured, financial retrospective review was conducted. Aggregate patient demographic data and billing data were collected regarding physician fee charges, collections, and patient visits for both PEDs. All ED visits from January 2009 to December 2013 were analyzed. Geographical information system mapping using ArcGIS mapped ED patient visits. Patient visits at the primary PED were 53,050 in 2009 before the satellite PED opened. The primary PED visits increased after opening the satellite PED to 55,932 in 2013. The satellite PED visits increased to 21,590 in 2013. Collections per visit at the primary PED decreased from $105.13 per visit in 2011 to $86.91 per visit in 2013. Total collections at the satellite PED decreased per visit from $155.41 per visit in 2011 to $128.53 per visit in 2013. After opening a nearby satellite PED, patient visits at the primary PED did not substantially decrease, suggesting that there was a previously unrecognized demand for PED services. The collections per ED visit were greater at the satellite ED, likely due to a higher collection rate.

  20. Patients' Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study.

    Science.gov (United States)

    Black, Georgia; Sheringham, Jessica; Spencer-Hughes, Vicki; Ridge, Melanie; Lyons, Mairead; Williams, Charlotte; Fulop, Naomi; Pritchard-Jones, Kathy

    2015-01-01

    Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emergency presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in an iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients' (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients' capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek

  1. Vascular access in pediatric patients in the emergency department: types of access, indications, and complications [digest].

    Science.gov (United States)

    Whitney, Rachel; Langhan, Melissa; Pade, Kathryn H

    2017-06-22

    Vascular access is a potentially life-saving procedure that is a mainstay of emergency medicine practice. There are a number of challenges associated with obtaining and maintaining vascular access, and the choice of the route of access and equipment used will depend on patient- and provider-specific factors. In this issue, the indications and complications of peripheral intravenous access, intraosseous access, and central venous access are reviewed. Timely and effective assessment and management of difficult-access patients, pain control techniques that can assist vascular access, and contraindications to each type of vascular access are also discussed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  2. 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

  3. Assessment of prehospital medical care for the patients transported to emergency department by ambulance

    Directory of Open Access Journals (Sweden)

    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

  4. [Peripheral venous catheter use in the emergency department: reducing adverse events in patients and biosafety problems for staff].

    Science.gov (United States)

    Tomás Vecina, Santiago; Mozota Duarte, Julián; Ortega Marcos, Miguel; Gracia Ruiz Navarro, María; Borillo, Vicente; San Juan Gago, Leticia; Roqueta Egea, Fermin; Chanovas Borrás, Manuel

    2016-01-01

    To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety.

  5. Microgrids: An emerging paradigm for meeting building electricityand heat requirements efficiently and with appropriate energyquality

    Energy Technology Data Exchange (ETDEWEB)

    Marnay, Chris; Firestone, Ryan

    2007-04-10

    The first major paradigm shift in electricity generation,delivery, and control is emerging in the developed world, notably Europe,North America, and Japan. This shift will move electricity supply awayfrom the highly centralised universal service quality model with which weare familiar today towards a more dispersed system with heterogeneousqualities of service. One element of dispersed control is the clusteringof sources and sinks into semi-autonomous mu grids (microgrids).Research, development, demonstration, and deployment (RD3) of mu gridsare advancing rapidly on at least three continents, and significantdemonstrations are currently in progress. This paradigm shift will resultin more electricity generation close to end-uses, often involvingcombined heat and power application for building heating and cooling,increased local integration of renewables, and the possible provision ofheterogeneous qualities of electrical service to match the requirementsof various end-uses. In Europe, mu grid RD3 is entering its third majorround under the 7th European Commission Framework Programme; in the U.S.,one specific mu grid concept is undergoing rigorous laboratory testing,and in Japan, where the most activity exists, four major publiclysponsored and two privately sponsored demonstrations are in progress.This evolution poses new challenges to the way buildings are designed,built, and operated. Traditional building energy supply systems willbecome much more complex in at least three ways: 1. one cannot simplyassume gas arrives at the gas meter, electricity at its meter, and thetwo systems are virtually independent of one another; rather, energyconversion, heat recovery and use, and renewable energy harvesting mayall be taking place simultaneously within the building energy system; 2.the structure of energy flows in the building must accommodate multipleenergy processes in a manner that permits high overall efficiency; and 3.multiple qualities of electricity may be supplied to

  6. Mortality Rates After Emergent Posterior Fossa Decompression for Ischemic or Hemorrhagic Stroke in Older Patients.

    Science.gov (United States)

    Puffer, Ross C; Graffeo, Christopher; Rabinstein, Alejandro; Van Gompel, Jamie J

    2016-08-01

    Cerebellar stroke causes major morbidity in the aging population. Guidelines from the American Stroke Association recommend emergent decompression in patients who have brainstem compression, hydrocephalus, or clinical deterioration. The objective of this study was to determine 30-day and 1-year mortality rates in patients >60 years old undergoing emergent posterior fossa decompression. Surgical records identified all patients >60 years old who underwent emergent posterior fossa decompression. Mortality rates were calculated at 30 days and 1 year postoperatively, and these rates were compared with patient and procedure characteristics. During 2000-2014, 34 emergent posterior fossa decompressions were performed in patients >60 years old. Mortality rates at 30 days were 0%, 33%, and 25% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age (alive at 30 days 75.2 years ± 1.7 vs. deceased 81.1 years ± 1.7, P = 0.01) and smaller craniectomy dimensions were associated with 30-day mortality. Mortality rates at 1 year were 0%, 50%, and 67% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age was significantly associated with mortality at 1 year (alive at 1 year 72.3 years ± 2.0 vs. deceased 81.1 years ± 1.2, P mortality. Age was independent of admission Glasgow Coma Scale score as a predictor of mortality at 30 days, 90 days, and 1 year postoperatively. Increasing age and smaller craniectomy size were significantly associated with mortality in patients undergoing emergent posterior fossa decompression. Among patients ≥80 years old, one-quarter were dead within 1 month of the operation, and more than two-thirds were dead within 1 year. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. The perception of the patient safety climate by professionals of the emergency department.

    Science.gov (United States)

    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.

  8. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

    Science.gov (United States)

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

  9. Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health.

    Science.gov (United States)

    Schwalfenberg, Gerry Kurt

    2017-01-01

    To review the evidence for the use of vitamin K supplementation in clinical conditions such as osteoporosis, vascular calcification, arthritis, cancer, renal calculi, diabetes, and warfarin therapy. PubMed was searched for articles on vitamin K (K1 and K2) along with books and conference proceedings and health conditions listed above. Level I and II evidence supports the use of vitamins K1 and K2 in osteoporosis and Level II evidence supports vitamin K2 in prevention of coronary calcification and cardiovascular disease. Evidence is insufficient for use in diabetes, arthritis, renal calculi, and cancer. Vitamin K2 may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity. It may also significantly reduce morbidity and mortality in cardiovascular health by reducing vascular calcification. Vitamin K2 appears promising in the areas of diabetes, cancer, and osteoarthritis. Vitamin K use in warfarin therapy is safe and may improve INR control, although a dosage adjustment is required. Vitamin K supplementation may be useful for a number of chronic conditions that are afflicting North Americans as the population ages. Supplementation may be required for bone and cardiovascular health.

  10. Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health

    Directory of Open Access Journals (Sweden)

    Gerry Kurt Schwalfenberg

    2017-01-01

    Full Text Available Objective. To review the evidence for the use of vitamin K supplementation in clinical conditions such as osteoporosis, vascular calcification, arthritis, cancer, renal calculi, diabetes, and warfarin therapy. Quality of Evidence. PubMed was searched for articles on vitamin K (K1 and K2 along with books and conference proceedings and health conditions listed above. Level I and II evidence supports the use of vitamins K1 and K2 in osteoporosis and Level II evidence supports vitamin K2 in prevention of coronary calcification and cardiovascular disease. Evidence is insufficient for use in diabetes, arthritis, renal calculi, and cancer. Main Message. Vitamin K2 may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity. It may also significantly reduce morbidity and mortality in cardiovascular health by reducing vascular calcification. Vitamin K2 appears promising in the areas of diabetes, cancer, and osteoarthritis. Vitamin K use in warfarin therapy is safe and may improve INR control, although a dosage adjustment is required. Conclusion. Vitamin K supplementation may be useful for a number of chronic conditions that are afflicting North Americans as the population ages. Supplementation may be required for bone and cardiovascular health.

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

    Science.gov (United States)

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

    2016-07-01

    Patient satisfaction is considered a measure of the status of the interaction between health- care professionals and service users. The level of this measure indicates the quality of the care received. Burnout is a common phenomenon in nursing professionals and it is a response to the chronic occupational stress. Different studies have shown a link between patient satisfaction and stress and burnout syndrome experienced by nursing personnel in various hospital units. The main objective of this study was to analyze the associations between patients' satisfaction with emergency services and perception of work stress and burnout by the nursing professionals who looked after these patients at a group level. The study followed a descriptive and cross-sectional design; the data were collected by means of questionnaires. Emergency services at two general hospitals in Murcia (Spain). Two samples, one formed of emergency service nursing professionals (n=148) and the other formed by patients (n=390), who were grouped in 48 units of analysis. To evaluate perception of stress and burnout of the nursing personnel, we used the Spanish adaptation of the Nursing Stress Scale for hospital emergency nursing personnel, and the Spanish adaptation of the Maslach Burnout Inventory, respectively. A Spanish adaptation of the La Mónica-Obsert Patient Satisfaction Scale was used to define the patients' feelings about their nursing care. Moreover, some socio-demographic variables and the length of stay in the emergency unit were included in the protocol. Before statistical analysis, the data were collated at a group level. The intraclass correlation coefficients and the Average Deviation Index support the aggregation of these data at a unit level. Neither perception of stress nor the various elements of burnout experienced by nursing staff were related to patients' levels of satisfaction. We observed a significant and positive association between stress perception among the nurses and two

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

    Directory of Open Access Journals (Sweden)

    Bock Beth C

    2007-05-01

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

  13. Effects of immigration enforcement legislation on Hispanic pediatric patient visits to the pediatric emergency department.

    Science.gov (United States)

    Beniflah, Jacob D; Little, Wendalyn K; Simon, Harold K; Sturm, Jesse

    2013-12-01

    To compare the visits by Hispanic patients to the pediatric emergency department (PED) before and after passage of Georgia House Bill 87 (HB87). This bill grants local law enforcement the authority to enforce immigration laws. A retrospective chart review of all Hispanic patients who presented to the PED in a 4-month period after implementation of HB87 in 2011 was conducted and compared with the same period in 2009 and 2010. Data compared included patient acuity score, disposition, payer status, and demographics. Fewer Hispanic patients presented to the ED after passage of the bill (18.3% vs 17.1%, P immigration legislation.

  14. Management of emergency caesarean section in a patient with decompensated critical aortic stenosis

    Directory of Open Access Journals (Sweden)

    Andrew C Leatherbarrow

    2018-01-01

    Full Text Available Increasing numbers of congenital heart disease patients are now surviving to child bearing age. This complex patient cohort present a great challenge to the obstetric anaesthetist and multidisciplinary teams. This report describes a rare case of a patient undergoing emergency caesarean section at 31 weeks gestation due to decompensated critical congenital aortic stenosis. The physiological effects of pregnancy in patients with aortic stenosis are discussed along with principles of managing anaesthesia for caesarean section in the presence of this cardiac lesion.

  15. Emerging Options for Emergency Contraception

    Directory of Open Access Journals (Sweden)

    Atsuko Koyama

    2013-01-01

    Full Text Available Emergency post-coital contraception (EC is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method, and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.

  16. Emerging Options for Emergency Contraception

    Science.gov (United States)

    Koyama, Atsuko; Hagopian, Laura; Linden, Judith

    2013-01-01

    Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference. PMID:24453516

  17. European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.

    Science.gov (United States)

    Miró, Òscar; Peacock, Frank W; McMurray, John J; Bueno, Héctor; Christ, Michael; Maisel, Alan S; Cullen, Louise; Cowie, Martin R; Di Somma, Salvatore; Martín Sánchez, Francisco J; Platz, Elke; Masip, Josep; Zeymer, Uwe; Vrints, Christiaan; Price, Susanna; Mebazaa, Alexander; Mueller, Christian

    2017-06-01

    Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.

  18. Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.

    Science.gov (United States)

    Bezzina, Andrew J; Smith, Peter B; Cromwell, David; Eagar, Kathy

    2005-01-01

    To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED. A Medline review of articles on primary care in ED and the definitions used. A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted. This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.

  19. Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis.

    Science.gov (United States)

    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.

  20. Modeling the emergency cardiac in-patient flow: An application of queueing theory

    NARCIS (Netherlands)

    de Bruin, A.M.; van Rossum, A.C.; Visser, M.C.; Koole, G.M.

    2007-01-01

    This study investigates the bottlenecks in the emergency care chain of cardiac in-patient flow. The primary goal is to determine the optimal bed allocation over the care chain given a maximum number of refused admissions. Another objective is to provide deeper insight in the relation between natural

  1. Suspected total spinal in patient having emergent Caesarean section, a case report and literature review

    Directory of Open Access Journals (Sweden)

    H. Virgin, MD

    2016-01-01

    Concluiosn: To perform spinal anaesthesia for emergent Caesarean in patients having an epidural for labour pain is a feasible option and should be considered in category 2–3 section. The dose for a convert spinal block should be assessed on an individual basis and reasonably reduced.

  2. [Prognostic factors of early 30-day mortality in elderly patients admitted to an emergency department].

    Science.gov (United States)

    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.

  3. Collaboration and patient safety at an emergency department - a qualitative case study.

    Science.gov (United States)

    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.

  4. Effect of music on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey.

    Science.gov (United States)

    Parlar Kilic, Serap; Karadag, Gulendam; Oyucu, Serpil; Kale, Ozlem; Zengin, Suat; Ozdemir, Emine; Korhan, Esra Akin

    2015-01-01

    The objective of this study is to evaluate the effect of music therapy on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey. This controlled and experimental study was conducted in the emergency department of a hospital in Turkey between July and October 2012. The study sample consisted of 200 patients in total, 100 forming the intervention group and 100 being the control group, who fell under color code green in the triage system and came with complaints of pain due to nausea/vomiting and diarrhea, abdominal pain, headaches, and joint pain. A questionnaire, the State Anxiety Scale, and the Visual Analog Scale to measure the patients' level of pain were used in the study. The questionnaires of the intervention group were administered after playing the music. When the intervention and control groups were compared, it was observed that there was a significant decrease in the VASP and STAI-S scores in favor of the intervention group. It was observed that 21.0% of the patients in the intervention group were very pleased to hear music in the emergency department, 58% of them were moderately or at least a little pleased, and 21.0% were not pleased at all. The results showed that music therapy had a positive effect in terms of reducing the severity of pain and the level of anxiety in patients, that only a very small portion of the patients were not pleased to listen to music in the emergency department. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

  5. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Michels, G; Hempel, D; Pfister, R; Janssens, U

    2018-04-09

    Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.

  6. Psychiatric emergency "surge capacity" following acts of terrorism and mass violence with high media impact: what is required?

    Science.gov (United States)

    Claassen, Cindy; Kashner, T Michael; Kashner, Tetyana K; Xuan, Lei; Larkin, Gregory L

    2011-01-01

    Adequate preparedness for acts of terrorism and mass violence requires a thorough understanding of the postdisaster mental health needs of all exposed groups, including those watching such events from a distance. This study examined emergency psychiatric treatment-seeking patterns following media exposure to four national terrorist or mass casualty events. An event was selected for study if (a) it precipitated local front-page headlines for >5 consecutive days and (b) emergency service psychiatrists identified it as specifically precipitating help-seeking in the study hospital. Four events qualified: the Oklahoma City bombing (1995), the Columbine High School (1999) and Wedgewood Baptist Church (1999) shootings and the terrorist attacks of September 11, 2001. Time-series analyses were used to correct for autocorrelation in visit patterns during the postdisaster week, and equivalent time periods from years before and after each event were used as control years. Overall, disaster week census did not differ significantly from predisaster weeks, although 3-day nonsignificant decreases in visit rate were observed following each disaster. Treatment-seeking for anxiety-related issues showed a nonsignificant increase following each disaster, which became significant in the "all disaster" model (t=5.17; P=.006). Intensity of media coverage did not impact rate of help-seeking in any analysis. Although these sentinel US disasters varied in scope, method, geographic proximity to the study site, perpetrator characteristics, public response, sequelae and degree of media coverage, the extent to which they impacted emergency department treatment-seeking was minimal. Geographically distant mass violence and disaster events of the type and scope studied here may require only minimal mental health "surge capacity" in the days following the event. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. The culture of patient safety from the perspective of the pediatric emergency nursing team

    Directory of Open Access Journals (Sweden)

    Taise Rocha Macedo

    Full Text Available Abstract OBJECTIVE To identify the patient safety culture in pediatric emergencies from the perspective of the nursing team. METHOD A quantitative, cross-sectional survey research study with a sample composed of 75 professionals of the nursing team. Data was collected between September and November 2014 in three Pediatric Emergency units by applying the Hospital Survey on Patient Safety Culture instrument. Data were submitted to descriptive analysis. RESULTS Strong areas for patient safety were not found, with areas identified having potential being: Expectations and actions from supervisors/management to promote patient safety and teamwork. Areas identified as critical were: Non-punitive response to error and support from hospital management for patient safety. The study found a gap between the safety culture and pediatric emergencies, but it found possibilities of transformation that will contribute to the safety of pediatric patients. CONCLUSION Nursing professionals need to become protagonists in the process of replacing the current paradigm for a culture focused on safety. The replication of this study in other institutions is suggested in order to improve the current health care scenario.

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

    Science.gov (United States)

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

    2009-01-01

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

  9. [Conflictive patients in the emergency room: Definition, classification and ethical aspects].

    Science.gov (United States)

    Herreros, B; García Casasola, G; Pintor, E; Sánchez, M A

    2010-09-01

    A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles ("mixed" patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts. Copyright 2009 Elsevier España, S.L. All rights reserved.

  10. Estimating the waiting time of multi-priority emergency patients with downstream blocking.

    Science.gov (United States)

    Lin, Di; Patrick, Jonathan; Labeau, Fabrice

    2014-03-01

    To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.

  11. Outcome after emergency surgery without angiography in patients with intracerebral haemorrhage after aneurysm rupture

    DEFF Research Database (Denmark)

    Bergdal, Ove; Springborg, Jacob; Hauerberg, John

    2009-01-01

    BACKGROUND: Patients with large intracerebral haematomas (ICH) from aneurysm rupture often present in a poor clinical condition and have a poor prognosis. Time delay for preoperative angiography might in some cases be unappealing. We evaluated the outcome after immediate haematoma removal...... and aneurysm occlusion without preoperative angiography. METHODS: We retrospectively identified 13 consecutive patients. We recorded clinical data and evaluated mortality and morbidity with the Glasgow Outcome Score (GOS) and Telephone Interview of Cognitive Status (TICS). FINDINGS: At follow up seven...... of thirteen patients had favourable outcome assessed by GOS. Three patients had severe disability and three patients died. None of the survived patients interviewed had impaired cognition. CONCLUSIONS: In patients presented in a critical state with aneurysmal ICH, emergency haematoma removal and aneurysm...

  12. Addressing overuse in emergency medicine: evidence of a role for greater patient engagement.

    Science.gov (United States)

    Newton, Erika H

    2017-12-01

    Overuse of health care refers to tests, treatments, and even health care settings when used in circumstances where they are unlikely to help. Overuse is not only wasteful, it threatens patient safety by exposing patients to a greater chance of harm than benefit. It is a widespread problem and has proved resistant to change. Overuse of diagnostic testing is a particular problem in emergency medicine. Emergency physicians cite fear of missing a diagnosis, fear of law suits, and perceived patient expectations as key contributors. However, physicians' assumptions about what patients expect are often wrong, and overlook two of patients' most consistently voiced priorities: communication and empathy. Evidence indicates that patients who are more fully informed and engaged in their care often opt for less aggressive approaches. Shared decision making refers to (1) providing balanced information so that patients understand their options and the trade-offs involved, (2) encouraging them to voice their preferences and values, and (3) engaging them-to the extent appropriate or desired-in decision making. By adopting this approach to discretionary decision making, physicians are better positioned to address patients' concerns without the use of tests and treatments patients neither need nor value.

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

    Science.gov (United States)

    Dahlen, Ingrid; Westin, Lars; Adolfsson, Annsofie

    2012-01-01

    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. 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. 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. 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.

  14. Warfarin Dosing Algorithms Underpredict Dose Requirements in Patients Requiring ≥7 mg Daily: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Saffian, S M; Duffull, S B; Wright, Dfb

    2017-08-01

    There is preliminary evidence to suggest that some published warfarin dosing algorithms produce biased maintenance dose predictions in patients who require higher than average doses. We conducted a meta-analysis of warfarin dosing algorithms to determine if there exists a systematic under- or overprediction of dose requirements for patients requiring ≥7 mg/day across published algorithms. Medline and Embase databases were searched up to September 2015. We quantified the proportion of over- and underpredicted doses in patients whose observed maintenance dose was ≥7 mg/day. The meta-analysis included 47 evaluations of 22 different warfarin dosing algorithms from 16 studies. The meta-analysis included data from 1,492 patients who required warfarin doses of ≥7 mg/day. All 22 algorithms were found to underpredict warfarin dosing requirements in patients who required ≥7 mg/day by an average of 2.3 mg/day with a pooled estimate of underpredicted doses of 92.3% (95% confidence interval 90.3-94.1, I 2 = 24%). © 2017 American Society for Clinical Pharmacology and Therapeutics.

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

    Science.gov (United States)

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

    2015-01-01

    Introduction Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions. Methods We studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen’s kappa, weighting the estimates to account for the ordinal responses. Results Overall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions. Conclusion ED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions. PMID:26759661

  16. Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.

    Science.gov (United States)

    McCord, James; Cabrera, Rafael; Lindahl, Bertil; Giannitsis, Evangelos; Evans, Kaleigh; Nowak, Richard; Frisoli, Tiberio; Body, Richard; Christ, Michael; deFilippi, Christopher R; Christenson, Robert H; Jacobsen, Gordon; Alquezar, Aitor; Panteghini, Mauro; Melki, Dina; Plebani, Mario; Verschuren, Franck; French, John; Bendig, Garnet; Weiser, Silvia; Mueller, Christian

    2017-02-01

    The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03). Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department. © 2017 American Heart Association, Inc.

  17. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

    Science.gov (United States)

    Lees, Mackenzie C.; Merani, Shaheed; Tauh, Keerit; Khadaroo, Rachel G.

    2015-01-01

    Background Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. Results Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007). Conclusion American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. PMID:26204143

  18. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  19. Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department.

    Science.gov (United States)

    Silvestre, Julio; Reddy, Akhila; de la Cruz, Maxine; Wu, Jimin; Liu, Diane; Bruera, Eduardo; Todd, Knox H

    2017-12-01

    Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center. We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids. The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home. Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.

  20. Patients Prefer Boarding in Inpatient Hallways: Correlation with the National Emergency Department Overcrowding Score

    Directory of Open Access Journals (Sweden)

    John R. Richards

    2011-01-01

    Full Text Available Objective. The boarding of patients in Emergency Department (ED hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS. Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42% patients preferred to be boarded in an inpatient hallway, 33 (33% preferred the ED hallway, and 24 (24% had no preference. Mean (±SD NEDOCS (range 0–200 was 136±46 for patients preferring inpatient boarding, 112±39 for ED boarding, and 119±43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

  1. Patients prefer boarding in inpatient hallways: correlation with the national emergency department overcrowding score.

    Science.gov (United States)

    Richards, John R; Ozery, Gal; Notash, Mark; Sokolove, Peter E; Derlet, Robert W; Panacek, Edward A

    2011-01-01

    Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS). Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0-200) was 136 ± 46 for patients preferring inpatient boarding, 112 ± 39 for ED boarding, and 119 ± 43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

  2. The Trauma Patient Tracking System: implementing a wireless monitoring infrastructure for emergency response.

    Science.gov (United States)

    Maltz, Jonathan; C Ng, Thomas; Li, Dustin; Wang, Jian; Wang, Kang; Bergeron, William; Martin, Ron; Budinger, Thomas

    2005-01-01

    In mass trauma situations, emergency personnel are challenged with the task of prioritizing the care of many injured victims. We propose a trauma patient tracking system (TPTS) where first-responders tag all patients with a wireless monitoring device that continuously reports the location of each patient. The system can be used not only to prioritize patient care, but also to determine the time taken for each patient to receive treatment. This is important in training emergency personnel and in identifying bottlenecks in the disaster response process. In situations where biochemical agents are involved, a TPTS may be employed to determine sites of cross-contamination. In order to track patient location in both outdoor and indoor environments, we employ both Global Positioning System (GPS) and Television/ Radio Frequency (TVRF) technologies. Each patient tag employs IEEE 802.11 (Wi-Fi)/TCP/IP networking to communicate with a central server via any available Wi-Fi basestation. A key component to increase TPTS fault-tolerance is a mobile Wi-Fi basestation that employs redundant Internet connectivity to ensure that tags at the disaster scene can send information to the central server even when local infrastructure is unavailable for use. We demonstrate the robustness of the system in tracking multiple patients in a simulated trauma situation in an urban environment.

  3. Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

    Science.gov (United States)

    Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

    2017-09-01

    Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. 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)

  5. Non-inflammatory causes of emergency consultation in patients with multiple sclerosis.

    Science.gov (United States)

    Rodríguez de Antonio, L A; García Castañón, I; Aguilar-Amat Prior, M J; Puertas, I; González Suárez, I; Oreja Guevara, C

    2018-05-26

    To describe non-relapse-related emergency consultations of patients with multiple sclerosis (MS): causes, difficulties in the diagnosis, clinical characteristics, and treatments administered. We performed a retrospective study of patients who attended a multiple sclerosis day hospital due to suspected relapse and received an alternative diagnosis, over a 2-year period. Demographic data, clinical characteristics, final diagnosis, and treatments administered were evaluated. Patients who were initially diagnosed with pseudo-relapse and ultimately diagnosed with true relapse were evaluated specifically. As an exploratory analysis, patients who consulted with non-inflammatory causes were compared with a randomly selected cohort of patients with true relapses who attended the centre in the same period. The study included 50 patients (33 were women; mean age 41.4±11.7years). Four patients (8%) were initially diagnosed with pseudo-relapse and later diagnosed as having a true relapse. Fever and vertigo were the main confounding factors. The non-inflammatory causes of emergency consultation were: neurological, 43.5% (20 patients); infectious, 15.2% (7); psychiatric, 10.9% (5); vertigo, 8.6% (4); trauma, 10.9% (5); and miscellaneous, 10.9% (5). MS-related symptoms constituted the most frequent cause of non-inflammatory emergency consultations. Close follow-up of relapse and pseudo-relapse is necessary to detect incorrect initial diagnoses, avoid unnecessary treatments, and relieve patients' symptoms. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.

    Science.gov (United States)

    Smith, Andrew F; Pope, Catherine; Goodwin, Dawn; Mort, Maggie

    2005-11-01

    Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.

  7. [Validation of a triage scale: first step in patient admission and in emergency service models].

    Science.gov (United States)

    Legrand, A; Thys, F; Vermeiren, E; Touwaide, M; D'Hoore, W; Hubin, V; Reynaert, M S

    2003-03-01

    At present, most emergency services handle the multitude of various demands in the same unity of place and by the same team of nurses aides, with direct consequences on the waiting time and in the handling of problems of varying degrees of importance. Our service examines other administrative models based on a triage of time and of orientation. In a prospective study on 679 patients, we have validated a triage tool inspired from the ICEM model (International Cooperation of Emergency Medicine) allowing patients to receive, while they wait, information and training, based on the resources provided, in order to deal with their particular medical problem. The validation of this tool was carried out in terms of its utilization as well as its reliability. It appears that, with the type of triage offered, there is a theoretical reserve of waiting time for the patients in which the urgency is relative, and which could be better used in the handling of more vital cases.

  8. Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

    Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

  9. Identification of intraluminal thrombus by ultrasonography in emergency department patients with acute deep venous thrombosis.

    Science.gov (United States)

    Mehta, Ninfa; Schecter, Joshua; Stone, Michael

    2012-05-01

    Traditionally, the diagnosis of deep venous thrombosis (DVT) using duplex ultrasonography (DU) has relied on the absence of venous compressibility. Visualization of an intraluminal thrombus is considered an uncommon finding. The purpose of this study is to determine the frequency of intraluminal thrombus in emergency department (ED) patients diagnosed with acute DVT. Retrospective chart review of adult ED patients with DU examinations demonstrating acute DVT. Patients with chronic DVT or patients in whom DU did not demonstrate DVT were excluded from data analysis. Study reports and ultrasound images were reviewed and analyzed for the presence of intraluminal thrombus. There were 189 patients who met inclusion criteria, of which 160 (85%) were found to have intraluminal thrombus. Intraluminal thrombi are present in the majority of patients in our ED in whom acute DVT is identified by DU. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Case report: Anesthesia management for emergency cesarean section in a patient with dwarfism.

    Science.gov (United States)

    Li, Xiaoxi; Duan, Hongjun; Zuo, Mingzhang

    2015-04-28

    Dwarfism is characterized by short stature. Pregnancy in women with dwarfism is uncommon and cesarean section is generally indicated for delivery. Patients with dwarfism are high-risk population for both general and regional anesthesia, let alone in an emergency surgery. In this case report we present a 27-year-old Chinese puerpera with dwarfism who underwent emergency cesarean section under combined spinal and epidural anesthesia. It is an original case report, which provides instructive significance for anesthesia management especially combined spinal and epidural anesthesia in this rare condition. There was only one former article that reported a puerpera who underwent combined spinal and epidural anesthesia for a selective cesarean section.

  11. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    Science.gov (United States)

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  12. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  13. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  14. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

    2016-01-01

    OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

  15. Analgesia (mis)usage on a dental emergency service: a patient survey.

    Science.gov (United States)

    Hommez, Geert; Ongena, B; Cauwels, R G E C; De Paepe, P; Christiaens, V; Jacquet, W

    2018-04-01

    Analgesics are one of the most frequently used medicines. Self-medication and misuse have been described in the literature. The purpose of this study was to document analgesic (mis)use in a population seeking emergency dental treatment. Patients consulting a dental emergency service were randomly asked to complete a questionnaire on analgesic use, knowledge and information on the analgesics and on their pain history. A photobook was used as an aid to identify products used. Descriptive statistics were combined with chi-square and Mann-Whitney U testing. Ninety-eight patients were included. Acetaminophen (69.4%) and ibuprofen (65.3%) were the most frequently used products. Nearly half of the subjects (43.9%) combined at least two analgesics. Although 42.9% of subjects were aware of the maximum daily dose, 62.2% of the subjects exceeded this limit, specifically 76.6% of subjects using ibuprofen and 32.4% of subjects using acetaminophen overdosing. Females overdosed significantly more than males. Ingestion on medical advice did not affect the overdose rates significantly. No significant relation was found between the absence of knowledge on the maximum daily dose and actual overdosing. No higher pain reduction was found in patients overdosing analgesics. The average number of days patients experienced pain before consulting the emergency unit was 12. A significant relation was found between the lag time and overdosing. A large portion of the patients overdosed analgesics. Even prior medical advice did not reduce significantly overdose rates. Dentists treating emergency cases clearly need to be aware of the high risk and high rates of overdosing analgesics in their patients.

  16. The culture of patient safety from the perspective of the pediatric emergency nursing team.

    Science.gov (United States)

    Macedo, Taise Rocha; Rocha, Patricia Kuerten; Tomazoni, Andreia; Souza, Sabrina de; Anders, Jane Cristina; Davis, Karri

    2016-01-01

    To identify the patient safety culture in pediatric emergencies from the perspective of the nursing team. A quantitative, cross-sectional survey research study with a sample composed of 75 professionals of the nursing team. Data was collected between September and November 2014 in three Pediatric Emergency units by applying the Hospital Survey on Patient Safety Culture instrument. Data were submitted to descriptive analysis. Strong areas for patient safety were not found, with areas identified having potential being: Expectations and actions from supervisors/management to promote patient safety and teamwork. Areas identified as critical were: Non-punitive response to error and support from hospital management for patient safety. The study found a gap between the safety culture and pediatric emergencies, but it found possibilities of transformation that will contribute to the safety of pediatric patients. Nursing professionals need to become protagonists in the process of replacing the current paradigm for a culture focused on safety. The replication of this study in other institutions is suggested in order to improve the current health care scenario. Identificar a cultura de segurança do paciente em emergências pediátricas, na perspectiva da equipe de enfermagem. Pesquisa quantitativa, tipo survey transversal. Amostra composta por 75 profissionais da equipe de enfermagem. Dados coletados entre setembro e novembro de 2014, em três Emergências Pediátricas, aplicando o instrumento Hospital Survey on Patient Safety Culture. Dados submetidos à análise descritiva. Não foram encontradas áreas de força para a segurança do paciente, sendo identificadas áreas com potencial de assim se tornarem: Expectativas e ações do supervisor/chefia para promoção da segurança do paciente e Trabalho em equipe. Como área crítica identificaram-se: Resposta não punitiva ao erro e Apoio da gestão hospitalar para segurança do paciente. O estudo apontou distanciamento

  17. Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids.

    Science.gov (United States)

    Conrardy, Michael; Lank, Patrick; Cameron, Kenzie A; McConnell, Ryan; Chevrier, Alison; Sears, Jill; Ahlstrom, Eric; Wolf, Michael S; Courtney, D Mark; McCarthy, Danielle M

    2016-01-01

    To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids. Mixed methods analysis of data from a randomized controlled trial. Urban academic ED (>88,000 visits). One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain. The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4–7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories. Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to “feel” addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction. In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government

  18. Analysis of patients presenting to the emergency department with carbon monoxide intoxication

    Directory of Open Access Journals (Sweden)

    Selim Yurtseven

    2015-12-01

    Full Text Available Objectives: Carbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT is of proven efficacy in the treatment of CO intoxication.The purpose of this study was to describe the general characteristics of carbon monoxide (CO intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT in these patients. Material and methods: Patients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively. Results: One hundred seventy-one patients were included; 140 (81.9% were poisoned by stoves, 18 (10.5% by hot water boilers and 10 in (5.8% by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5% of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%. One patient died after 15 session of HBOT. Conclusion: Although elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT. Keywords: Carbon monoxide intoxication, Hyperbaric oxygen, Troponin I, Echocardiography

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

    Science.gov (United States)

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

    2016-01-01

    Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes. PMID:27057847

  20. Level of agitation of psychiatric patients presenting to an emergency department.

    Science.gov (United States)

    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

  1. Utility of the History and Physical Examination in the Detection of Acute Coronary Syndromes in Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Zachary DW Dezman

    2017-05-01

    Full Text Available Chest pain accounts for approximately 6% of all emergency department (ED visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS. This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association. The purpose of this article was to summarize the findings of recent investigations regarding the ability of various components of the history and physical examination to identify which patients presenting to the ED with chest pain require further investigation for possible ACS. Previous studies have consistently identified a number of factors that increase the probability of ACS. These include radiation of the pain, aggravation of the pain by exertion, vomiting, and diaphoresis. Traditional cardiac risk factors identified by the Framingham Heart Study are of limited diagnostic utility in the ED. Clinician gestalt has very low predictive ability, even in patients with a non-diagnostic electrocardiogram (ECG, and gestalt does not seem to be enhanced appreciably by clinical experience. The history and physical alone are unable to reduce a patient’s risk of ACS to a generally acceptable level (<1%. Ultimately, our review of the evidence clearly demonstrates that “atypical” symptoms cannot rule out ACS, while “typical” symptoms cannot rule it in. Therefore, if a patient has symptoms that are compatible with ACS and an alternative cause cannot be identified, clinicians must strongly consider the need for further investigation with ECG and troponin measurement.

  2. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  3. Short and long-term mortality of patients presenting with bleeding events to the Emergency Department.

    Science.gov (United States)

    Conti, Alberto; Renzi, Noemi; Molesti, Daniele; Bianchi, Simone; Bogazzi, Irene; Bongini, Giada; Pepe, Giuseppe; Frosini, Fabiana; Bertini, Alessio; Santini, Massimo

    2017-12-01

    Death of patients presenting with bleeding events to the Emergency Department still represent a major problem. We sought to analyze clinical characteristics associated with worse outcomes including short- and long-term death, beyond antithombotic treatment strategy. Patients presenting with any bleeding events during 2016-2017years were enrolled. Clinical parameters, site of bleeding, major bleeding, ongoing anti-thrombotic treatment strategy and death were collected. Hard 5:1 propensity score matching was performed to adjust dead patients in baseline characteristics. Endpoints were one-month and one-year death. Out of 166,000 visits to the Emergency Department, 3.050 patients (1.8%) were enrolled and eventually 429 were analyzed after propensity. Overall, anticoagulants or antiplatelets were given to 234(54%). Major bleeding account for 111(26%) patients, without differences between those taking anticoagulants or antiplatelets versus others. Death at one-month and one-year was 26(6%) and 72(17%), respectively. Independent predictors of one-month death were major bleeding (Odds Ratio, OR 26, pbleeding (OR 7, pbleeding where higher than others (pbleeding and age (0.75 and 0.72, respectively) over others; pbleeding events, death rate was driven by major bleeding on short-term and older age on long-term. Among dead patients mortality was approximately 40% on one-month; 60% in older patients, and 80% in female gender. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Health smart cards: differing perceptions of emergency department patients and staff.

    Science.gov (United States)

    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.

  5. The information needs of patients receiving procedural sedation in a hospital emergency department.

    Science.gov (United States)

    Revell, Sue; Searle, Judy; Thompson, Shona

    2017-07-01

    This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation. They identified very few gaps in terms of specific information they needed pertaining to procedural sedation and rejected the need for receiving information in a written format. Their information needs related to a central concern for safety and trust. Focus groups, reflecting on the findings from patients, were conducted with five ED nurses and four emergency medicine consultants/registrars who regularly provided procedural sedation. Themes that emerged from the analysis of data from all three groups identified the issues concerning patient information needs as being: competence and efficiency of staff; explanations of procedures and progress; support person presence; and medico-legal issues. The research confirms that the quality of the patient's ED experience, specifically related to procedural sedation, is enhanced by ED staff, especially nurses, providing them with ongoing and repeated verbal information relevant to their circumstances. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Utilization of Emergency Medical Service Increases Chance of Thrombolytic Therapy in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Hsieh, Ming-Ju; Tang, Sung-Chun; Chiang, Wen-Chu; Huang, Kuang-Yu; Chang, Anna Marie; Ko, Patrick Chow-In; Tsai, Li-Kai; Jeng, Jiann-Shing; Ma, Matthew Huei-Ming

    2014-01-01

    Objective To determine whether utilization of emergency medical service (EMS) can expedite and improve the rate of thrombolytic therapy administration in acute ischemic stroke patients. Methods This is a prospective observational study of consecutive patients presenting to the emergency department (ED) with an ischemic stroke within 72 hours of symptom onset. Variables associated with early ED arrival (within 3 hours of stroke onset), and administration of thrombolytic therapy were analyzed. We also evaluated the factors related to onset-to-needle time in patients receiving thrombolytic therapy. Results From January 1, 2010 to July 31, 2011, there were 1081 patients (62.3% men, age 69.6 ± 13 years) included in this study. Among them, 289 (26.7%) arrived in the ED within 3 hours, and 88 (8.1%) received intravenous thrombolytic therapy. Patients who arrived to the ED by EMS (n=279, 25.8 %) were independently associated with earlier ED arrival (adjusted odds ratio [OR] = 3.68, 95% confidence interval [CI] = 2.54 to 5.33), and higher chance of receiving thrombolytic therapy (adjusted OR = 3.89, 95% CI= 1.86 to 8.17). Furthermore, utilization of EMS decreased onset-to-needle time by 26 minutes in patients receiving thrombolytic therapy. Conclusion Utilization of EMS can help acute ischemic stroke patients in early presentation to ED, facilitate thrombolytic therapy, and reduce the onset to needle time. PMID:24296308

  7. Emergence of clonal hematopoiesis in the majority of patients with acquired aplastic anemia.

    Science.gov (United States)

    Babushok, Daria V; Perdigones, Nieves; Perin, Juan C; Olson, Timothy S; Ye, Wenda; Roth, Jacquelyn J; Lind, Curt; Cattier, Carine; Li, Yimei; Hartung, Helge; Paessler, Michele E; Frank, Dale M; Xie, Hongbo M; Cross, Shanna; Cockroft, Joshua D; Podsakoff, Gregory M; Monos, Dimitrios; Biegel, Jaclyn A; Mason, Philip J; Bessler, Monica

    2015-04-01

    Acquired aplastic anemia (aAA) is a nonmalignant disease caused by autoimmune destruction of early hematopoietic cells. Clonal hematopoiesis is a late complication, seen in 20-25% of older patients. We hypothesized that clonal hematopoiesis in aAA is a more general phenomenon, which can arise early in disease, even in younger patients. To evaluate clonal hematopoiesis in aAA, we used comparative whole exome sequencing of paired bone marrow and skin samples in 22 patients. We found somatic mutations in 16 patients (72.7%) with a median disease duration of 1 year; of these, 12 (66.7%) were patients with pediatric-onset aAA. Fifty-eight mutations in 51 unique genes were found primarily in pathways of immunity and transcriptional regulation. Most frequently mutated was PIGA, with seven mutations. Only two mutations were in genes recurrently mutated in myelodysplastic syndrome. Two patients had oligoclonal loss of the HLA alleles, linking immune escape to clone emergence. Two patients had activating mutations in key signaling pathways (STAT5B (p.N642H) and CAMK2G (p.T306M)). Our results suggest that clonal hematopoiesis in aAA is common, with two mechanisms emerging-immune escape and increased proliferation. Our findings expand conceptual understanding of this nonneoplastic blood disorder. Future prospective studies of clonal hematopoiesis in aAA will be critical for understanding outcomes and for designing personalized treatment strategies. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Identification of fall risk factors in older adult emergency department patients.

    Science.gov (United States)

    Carpenter, Christopher R; Scheatzle, Mark D; D'Antonio, Joyce A; Ricci, Paul T; Coben, Jeffrey H

    2009-03-01

    Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after

  9. False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients.

    Science.gov (United States)

    Weaver, Lindell K; Churchill, Susan K; Deru, Kayla; Cooney, Darryl

    2013-02-01

    Symptoms of carbon monoxide (CO) poisoning are non-specific. Diagnosis requires suspicion of exposure, confirmed by measuring ambient CO levels or carboxyhemoglobin (COHb). An FDA-approved pulse oximeter (Rad-57) can measure CO saturation (S(pCO)). The device accuracy has implications for clinical decision-making. From April 1 to August 15, 2008, study personnel measured S(pCO) and documented demographic factors at time of clinical blood draw, in a convenience sample of 1,363 subjects presenting to the emergency department at Intermountain Medical Center, Murray, Utah. The technician then assayed COHb. COHb and S(pCO) values were compared by subject; false positive or negative values were defined as S(pCO) at least 3 percentage points greater or less than COHb level, reported by the manufacturer to be ± 1 SD in performance. In 1,363 subjects, 613 (45%) were male, 1,141 (84%) were light-skinned, 14 in shock, 4 with CO poisoning, and 122 (9%) met the criteria for a false positive value (range 3-19 percentage points), while 247 (18%) met the criteria for a false negative value (-13 to -3 percentage points). Risks for a false positive S(pCO) reading included being female and having a lower perfusion index. Methemoglobin, body temperature, and blood pressure also appear to influence the S(pCO) accuracy. There was variability among monitors, possibly related to technician technique, as rotation of monitors among technicians was not enforced. While the Rad-57 pulse oximeter functioned within the manufacturer's specifications, clinicians using the Rad-57 should expect some S(pCO) readings to be significantly higher or lower than COHb measurements, and should not use S(pCO) to direct triage or patient management. An elevated S(pCO) could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative S(pCO) level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb. © 2013

  10. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Science.gov (United States)

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  11. Patient satisfaction with wait times at an emergency ophthalmology on-call service.

    Science.gov (United States)

    Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

    2018-04-01

    To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  12. Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

    Science.gov (United States)

    Rusticucci, Matilde; Bettolli, Laura M.; de los Angeles Harris, M.

    2002-02-01

    The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.

  13. Impact on Quality of Life in Dermatology Patients Attending an Emergency Department.

    Science.gov (United States)

    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.

  14. Does this adult patient with suspected bacteremia require blood cultures?

    Science.gov (United States)

    Coburn, Bryan; Morris, Andrew M; Tomlinson, George; Detsky, Allan S

    2012-08-01

    Clinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful. To review the accuracy of easily obtained clinical and laboratory findings to inform the decision to obtain blood cultures in suspected bacteremia. A MEDLINE and EMBASE search (inception to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accuracy of clinical variables for bacteremia in adult immunocompetent patients, representing 4566 bacteremia and 25,946 negative blood culture episodes. Data were extracted to determine the prevalence and likelihood ratios (LRs) of findings for bacteremia. The pretest probability of bacteremia varies depending on the clinical context, from low (eg, cellulitis: 2%) to high (eg, septic shock: 69%). Elevated temperatures alone do not accurately predict bacteremia (for ≥38°C [>100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for ≥38.5°C [>101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability. SIRS and the decision rule may be helpful in identifying patients who do not need blood cultures. These conclusions do not apply to immunocompromised patients or when endocarditis is suspected.

  15. Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh

    Science.gov (United States)

    Haider, Rafiqul; Abdullah, Abu Yousuf Md; Christou, Aliki; Ali, Nabeel Ashraf; Rahman, Ahmed Ehsnaur; Iqbal, Afrin; Bari, Sanwarul; Hoque, D. M. Emdadul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.

    2018-01-01

    Background A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project. Methods A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities. Results Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased. Conclusions The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings. PMID

  16. Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

    OpenAIRE

    Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

    2012-01-01

    It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluati...

  17. Ankle Fracture Surgery on a Pregnant Patient Complicated by Intraoperative Emergency Caesarian Section

    Directory of Open Access Journals (Sweden)

    Ran Schwarzkopf

    2013-01-01

    Full Text Available We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient.

  18. Analyzing patient's waiting time in emergency & trauma department in public hospital - A case study

    Science.gov (United States)

    Roslan, Shazwa; Tahir, Herniza Md; Nordin, Noraimi Azlin Mohd; Zaharudin, Zati Aqmar

    2014-09-01

    Emergency and Trauma Department (ETD) is an important element for a hospital. It provides medical service, which operates 24 hours a day in most hospitals. However overcrowding is not exclusion for ETD. Overflowing occurs due to affordable services provided by public hospitals, since it is funded by the government. It is reported that a patient attending ETD must be treated within 90 minutes, in accordance to achieve the Key Performance Indicator (KPI). However, due to overcrowd situations, most patients have to wait longer than the KPI standard. In this paper, patient's average waiting time is analyzed. Using Chi-Square Test of Goodness, patient's inter arrival per hour is also investigated. As conclusion, Monday until Wednesday was identified as the days that exceed the KPI standard while Chi-Square Test of Goodness showed that the patient's inter arrival is independent and random.

  19. An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

    Science.gov (United States)

    Khan, Rasheda; Sultana, Marzia; Bilkis, Sayeda; Koblinsky, Marge

    2012-01-01

    Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health

  20. Maryland's Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients' Outcomes.

    Science.gov (United States)

    Hirshon, Jon Mark; Galvagno, Samuel M; Comer, Angela; Millin, Michael G; Floccare, Douglas J; Alcorta, Richard L; Lawner, Benjamin J; Margolis, Asa M; Nable, Jose V; Bass, Robert R

    2016-03-01

    Helicopter emergency medical services (EMS) has become a well-established component of modern trauma systems. It is an expensive, limited resource with potential safety concerns. Helicopter EMS activation criteria intended to increase efficiency and reduce inappropriate use remain elusive and difficult to measure. This study evaluates the effect of statewide field trauma triage changes on helicopter EMS use and patient outcomes. Data were extracted from the helicopter EMS computer-aided dispatch database for in-state scene flights and from the state Trauma Registry for all trauma patients directly admitted from the scene or transferred to trauma centers from July 1, 2000, to June 30, 2011. Computer-aided dispatch flights were analyzed for periods corresponding to field triage protocol modifications intended to improve system efficiency. Outcomes were separately analyzed for trauma registry patients by mode of transport. The helicopter EMS computer-aided dispatch data set included 44,073 transports. There was a statewide decrease in helicopter EMS usage for trauma patients of 55.9%, differentially affecting counties closer to trauma centers. The Trauma Registry data set included 182,809 patients (37,407 helicopter transports, 128,129 ambulance transports, and 17,273 transfers). There was an increase of 21% in overall annual EMS scene trauma patients transported; ground transports increased by 33%, whereas helicopter EMS transports decreased by 49%. Helicopter EMS patient acuity increased, with an attendant increase in patient mortality. However, when standardized with W statistics, both helicopter EMS- and ground-transported trauma patients showed sustained improvement in mortality. Modifications to state protocols were associated with decreased helicopter EMS use and overall improved trauma patient outcomes. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  1. Retrospective evaluation of patients with elevated digoxin levels at an emergency department

    Directory of Open Access Journals (Sweden)

    Gulsum Limon

    2016-03-01

    Full Text Available Objectives: We investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED with digoxin levels at or above 1.2 ng/ml. Materials and methods: The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity. Results: In this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P = 0.03. The most common comorbidities were congestive heart failure (n = 91 and atrial fibrillation (n = 74. The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher. Conclusion: Digoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined. Keywords: Digoxin, Digoxin level, Intoxication, Emergency department

  2. Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

    Science.gov (United States)

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

    2017-04-01

    Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

  3. [Opportunities to improve hospital emergency care of patients with diabetic ketoacidosis].

    Science.gov (United States)

    Navarro-Díaz, Francisco José; Amillo, Mónica; Rosales, María; Panadero, Ana; Ena, Javier

    2015-02-01

    To identify opportunities to improve the care of adult patients with diabetic ketoacidosis in the emergency room. Retrospective observational study of records for 2010 to 2013. Searching for International Classification of Diseases discharge codes 250.1–250.3 we identified patients who met the following 3 criteria: ketonuria of 100 mg/dL or more, diagnosed diabetes or glucose concentration of 250 mg/dL or more, and venous blood pH below 7.30 (or venous bicarbonate concentration less than 18 mEq/L). We reviewed the cases to extract patient and clinical characteristics and time from triage until diagnosis and start of treatment. The findings were compared with recommendations in clinical practice guidelines. We identified 49 episodes of diabetic ketoacidosis (4 mild, 32 moderate, and 13 severe) in 43 patients. The median delay between triage until the first blood test results were available was 142 minutes (range, 59-597 minutes). In 50% of the cases fluid therapy was delayed beyond the time recommended in clinical practice guidelines. Intravenous insulin was also delayed (in 66%) and insuficient intravenous potassium was given in 65%. Sodium bicarbonate was overused (in 50%). Half the patients developed hypokalemia in the hospital. Diagnosis and initiation of treatment were often delayed for patients with diabetic ketoacidosis in our emergency department.

  4. Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

    Science.gov (United States)

    Sharma, Anurag; Inder, Brett

    2011-08-01

    To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

  5. Challenges for the registration of vaccines in emerging countries: Differences in dossier requirements, application and evaluation processes.

    Science.gov (United States)

    Dellepiane, Nora; Pagliusi, Sonia

    2018-06-07

    The divergence of regulatory requirements and processes in developing and emerging countries contributes to hamper vaccines' registration, and therefore delay access to high-quality, safe and efficacious vaccines for their respective populations. This report focuses on providing insights on the heterogeneity of registration requirements in terms of numbering structure and overall content of dossiers for marketing authorisation applications for vaccines in different areas of the world. While it also illustrates the divergence of regulatory processes in general, as well as the need to avoid redundant reviews, it does not claim to provide a comprehensive view of all processes nor existing facilitating mechanisms, nor is it intended to touch upon the differences in assessments made by different regulatory authorities. This report describes the work analysed by regulatory experts from vaccine manufacturing companies during a meeting held in Geneva in May 2017, in identifying and quantifying differences in the requirements for vaccine registration in three aspects for comparison: the dossier numbering structure and contents, the application forms, and the evaluation procedures, in different countries and regions. The Module 1 of the Common Technical Document (CTD) of 10 countries were compared. Modules 2-5 of the CTDs of two regions and three countries were compared to the CTD of the US FDA. The application forms of eight countries were compared and the registration procedures of 134 importing countries were compared as well. The analysis indicates a high degree of divergence in numbering structure and content requirements. Possible interventions that would lead to significant improvements in registration efficiency include alignment in CTD numbering structure, a standardised model-application form, and better convergence of evaluation procedures. Copyright © 2018.

  6. Emergency department physicians spend only 25% of their working time on direct patient care

    DEFF Research Database (Denmark)

    Füchtbauer, Laila Maria; Nørgaard, Birgitte; Mogensen, Christian Backer

    2013-01-01

    In modern hospital medicine, there is a growing awareness of the need for efficient and secure -patient care. Authorities seek to improve this by adding requirements for documentation, administrative tasks and standardized patient programmes. However, it is rarely investigated how much time...

  7. Why do general medical patients have a lengthy wait in the emergency department before admission?

    Directory of Open Access Journals (Sweden)

    Nin-Chieh Hsu

    2014-08-01

    Conclusion: Complex comorbidities and terminal conditions with DNR consent were associated with the prolonged ED stay for general medical patients. The hospital manager should pay attention to general medical patients with multiple comorbidities as well as those who require palliative care.

  8. HPV specific testing: a requirement for oropharyngeal squamous cell carcinoma patients.

    Science.gov (United States)

    Robinson, Max; Schache, Andrew; Sloan, Philip; Thavaraj, Selvam

    2012-07-01

    Human papillomavirus (HPV) testing is now recommended as part of the work up for patients with oropharyngeal squamous cell carcinoma (OPSCC) and those patients with cervical lymph node metastasis of unknown origin. The laboratory testing strategy should accurately assess the presence or absence of oncogenic HPV infection in routinely collected tumour samples that are subject to standard fixation protocols, alcohol-fixed cytological preparations and formalin-fixed tissue samples. The HPV status should correlate with biologically relevant outcome measures such as overall, disease-specific and disease-free survival. Whilst increased expression of p16 by immunohistochemistry is considered to be a surrogate marker of oncogenic HPV infection and is a validated independent prognostic biomarker, only HPV specific tests provide definitive evidence of the aetiological agent. We provide an overview of HPV testing in OPSCC, justifying the use of HPV specific tests. We examine the analytical accuracy of HPV specific tests against the 'reference' test--high risk HPV mRNA in fresh tissue--and contrast this with the performance of p16 immunohistochemistry as a stand alone test. We highlight the added value of HPV specific tests in prognostication, clinical trial design, and population-based disease surveillance. We consider that HPV specific testing is the starting point for developing increasingly informative biomarker panels in the context of 'stratified medicine'. We briefly frame test information in the context of disclosure of HPV status to patients. We conclude that only a testing strategy that includes HPV specific tests can deliver more effective care for patients with OPSCC. The international head and neck oncology community should work together to clearly define the minimum requirements for assigning a diagnosis of HPV-related OPSCC in order to ensure consistent reporting of this emerging and increasingly prevalent disease.

  9. Disposition of Patients Before and After Establishment of Emergency Medicine Specialists

    Directory of Open Access Journals (Sweden)

    Payman Asadi

    2014-09-01

    Full Text Available Introduction: Emergency department (ED as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.  Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001. The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001. Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001. The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002. Also, during 2005-2008 the

  10. Acute kidney injury in pediatric patients: diagnosis and management in the emergency department [digest].

    Science.gov (United States)

    Mohrer, Daniel; Langhan, Melissa; Chaudhari, Pradip

    2017-05-22

    Pediatric acute kidney injury is a condition that is underdiagnosed among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock, and cardiac dysfunction. This issue compares 3 classification systems for the diagnosis and staging of acute kidney injury and reviews the etiologies that lead to kidney injury in children. The management of pediatric acute kidney injury focuses on identifying patients at high risk, monitoring intravascular volume status, avoiding nephrotoxic medication exposure, and involving a pediatric nephrologist once acute kidney injury is diagnosed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  11. Report on the costs of domestic and international emergencies and on the threats posed by the Kuwaiti oil fires as required by P. L. 102-55

    Energy Technology Data Exchange (ETDEWEB)

    1991-06-01

    The report fulfills the requirements of Public Law 12-55, the FY 1992 dire emergency supplemental appropriations bill, signed by the President on June 13, 1991. This law required the Director of the Office of Management and Budget to prepare and submit to the appropriate committees of Congress a report on: unfunded costs of dire emergencies because of floods, droughts, tornadoes, unemployment, and other disasters in the United States; unfunded costs, including food assistance, of international disaster emergencies existing because of floods, droughts, tornadoes, and other disasters; and the threats to oil supply, human health, and the environment that the Kuwaiti oil fires might pose.

  12. Emergency department patients self-report higher patient inertia, hopelessness, and harmful lifestyle choices than community counterparts.

    Science.gov (United States)

    Joyner, JaNae; Moore, Ashley R; Mount, David L; Simmons, Debra R; Ferrario, Carlos M; Cline, David M

    2012-12-01

    Patient inertia is defined as an individual's failure to take responsibility for proactive lifestyle change and health conditions including hypertension. Generalized and hypertension-specific patient inertia factors were compared in 110 patients (48% women; 52% African American) from a Forsyth County, NC, emergency department (ED) and 104 community members (79% women; 70% African American) using the patient inertia-facilitated