An evaluation of the reasons why patients attend a hospital Emergency Department

This survey evaluates the attendance patterns of people who responded to a two part questionnaire (before and after treatment) regarding the reasons they had presented at a hospital Emergency Department co located with an Urgent Care Centre. A total 485 people responded before treatment and 163 people responded after completing treatment. People have deep rooted convictions that the ‘hospital’ is the best place to be seen for the treatment of their accident or perceived emergency, together with a considerable loyalty and emotional attachment to it. Few people knew that Urgent Care facilities existed within the Emergency Department and fewer what they were for. Some were frustrated at the apparent speed of access to care by those with apparently trivial problems, not understanding that they were accessing a different service. On the whole people who attended were happy with the advice and treatment they received.     

The Effect of Emergency Department Expansion on Emergency Department Overcrowding

Objectives: To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center. Methods: This was a pre‐post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five‐month pre‐expansion period (November 1, 2004, to March 1, 2005) and a five‐month postexpansion period (June 1, 2005, to October 31, 2005) were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders. Results: From pre‐expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI =?74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI =?4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI =?4.0 to 3.5). Mean (±SD) total LOS increased from 4.6 (±1.9) to 5.6 (±2.3) hours, and mean (±SD) admission hold LOS also increased from 3.0 (±0.2) to 4.1 (±0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre‐expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode. Conclusions: An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital.     

Psychosocial assessment of patients who attend an accident and emergency department with self-harm

It has been recommended that all patients attending hospital accident and emergency departments in the United Kingdom (UK) with self-harm should be offered adequate psychosocial assessment to identify those at risk of completed suicide or repeated self-harm. This paper focuses on the extent to which this recommendation has been implemented in a large district general hospital in Wales, and compares the characteristics and hospital management of patients who received no specialist assessment with those who were assessed by a psychiatric liaison nurse or a psychiatrist. Data were routinely collected as part of the hospital annual audit procedure and confirm previous findings that guidelines for the general hospital management of self-harm patients have not been well implemented. Whilst we found some evidence that certain high risk patient groups were more likely to receive specialist assessment, this was far from universal. We conclude that if there is to be a reduction in the rate of suicide in Wales and the UK as a whole, it is crucial that services for people who self-harm are more appropriately targeted on patients who are at greatest risk.     

Perception of general health in adults with congenital heart disease who no longer attend medical follow-up

Background

Numerous patients with congenital heart disease (CHD) do not attend regular follow-up. How these patients perceive their health is unknown. A news story recently reached the front pages in Denmark, stating that patients with CHD not attending medical follow-up could be at great risk. This made a number of “lost” patients come forward and offered a unique opportunity to learn more about how these patients manage life.

Aims

To describe the perception of general health in a sample of grown-up congenital heart disease (GUCH) patients who are no longer in medical follow-up and to determine whether patients feel affected in daily life because of their heart disease.

Methods

A convenient sample of 125 respondents was asked to complete a questionnaire, using questions from Short Form 36 and self-constructed questions. Data were processed in SPSS and analysed by means of Student's t-test, ANOVA, Chi-square test, and Pearson's correlation coefficient.

Results

125 patients participated, with a mean age of 38 years, 37% were men. Mean scores for general health perception were 75.8 for men and 77.2 for women. The scores seem to follow the pattern seen in the general population. Most patients, 83%, did not feel limited in their daily activities. 67% of women and 52% of men, however, worried about their heart disease.

Conclusion

Patients not attending medical follow-up seem to be affected to some degree by their heart disease.     

Comparison of the National Emergency Department Overcrowding Scale and the Emergency Department Work Index for Quantifying Emergency Department Crowding

Background: Emergency department (ED) crowding is just beginning to be quantified. The only two scales presently available are the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN). Objectives: To assess the value of the NEDOCS and the EDWIN in predicting overcrowding. The hypothesis of this study was that the NEDOCS and the EDWIN would be equally sensitive and specific for overcrowding. Methods: The NEDOCS, the EDWIN, and an overcrowding measure (OV) were determined every two hours for a ten‐day period in December 2004. The NEDOCS is a statistically derived calculation, and the EDWIN is a formula‐based calculation. The overcrowding measure is a composite of physician and charge nurse expert opinion on the degree of overcrowding as measured on a 100‐mm visual analogue scale (VAS). The primary outcome, overcrowding, was based on the dichotomized OV VAS score at the midpoint of 50 mm (≥50, overcrowded; <50, not overcrowded). The area under the receiver operator characteristic curve (AUC) and an index of adequacy (relative prognostic content) of each measure, on the basis of the likelihood ratio chi‐square statistic, were computed to evaluate the performance of NEDOCS and EDWIN. Results: There were 130 completed sampling times over ten days. The OV indicated that the ED was overcrowded 62% of the time. The AUC for the NEDOCS was 0.83 (95% CI = 0.75 to 0.90), and the AUC for the EDWIN was 0.80 (95% CI = 0.73 to 0.88). The NEDOCS score accounts for 97% of the prognostic information provided by combining all variables used in each model into one combined model. The EDWIN score accounts for only 86% (χ² test for difference, p = 0.02). Conclusions: Both scales had high AUCs, correlated well with each other, and showed good discrimination for predicting ED overcrowding. This establishes construct validity for these scales as measures of overcrowding. Which scale is used in an ED is dependent on which set of data is most readily available, with the favored scale being the NEDOCS.     

Emergency Department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the Emergency Department

Emergency Department (ED) crowding and ambulance diversion have been increasingly significant national problems for more than a decade. Surveys of hospital directors have reported overcrowding in almost every state and 91% of hospital ED directors report overcrowding as a problem. The problem has developed because of multiple factors in the past 20 years, including a steady downsizing in hospital capacity, closures of a significant number of EDs, increased ED volume, growing numbers of uninsured, and deceased reimbursement for uncompensated care. Initial position statements from major organizations, including JCAHO and the General Accounting Office, suggested the problem of overcrowding was due to inappropriate use of emergency services by those with no urgent conditions, probably cyclical, and needed no specific policy response. More recently, the same and other organizations have more forcefully highlighted the problem of overcrowding and focused on the inability to transfer emergency patients to inpatient beds as the single most important factor contributing to ED overcrowding. This point has been further solidified by initial overcrowding research. This article will review how overcrowding occurred with a focus on the significance and potential remedies of extended boarding of admitted patients in the Emergency Department.     

小儿胆脂瘤型中耳炎显微手术的围手术期护理

小儿胆脂瘤型中耳炎是较成年人胆脂瘤型中耳炎更具侵袭性的耳科常见病。手术治疗胆脂瘤的基本目标是去除病灶、提供干耳以及保存和恢复听力。小儿鼓管机能相对差，易患上呼吸道感染，中耳局部的免疫功能不完全等特点导致小儿胆瘤进展快、症状重。另外，小儿耳道骨性部分正处于发育期，尽量保留生理性结构显得比成人更重要。正确合理的围手术期护理，是保证手术成功的一个重要组成部分。笔者将护理经验进行总结，现报道如下。