Breath analyzer screening of emergency department patients suspected of alcohol intoxication

Background

Acute alcohol intoxication is a frequent cause of emergency department (ED) visits. Evaluating a patient’s alcohol intoxication is commonly based on both a physical examination and determination of blood alcohol concentration (BAC).

Objective

To demonstrate the feasibility and usefulness of using a last-generation infrared breath analyzer as a non-invasive and rapid screening tool for alcohol intoxication in the ED.

Methods

Adult patients suspected of acute alcohol intoxication were prospectively enrolled over 10 days. Breath alcohol concentrations (BrAC) were measured using a handheld infrared breath analyzer. BAC was determined simultaneously by automated enzymatic analysis of a venous blood sample. The relationship between BAC and BrAC values was examined by both linear regression and Bland-Altman analysis.

Results

The study included 54 patients (mean age 40 ± 14 years, sex ratio M/F of 3/1). Breath and blood alcohol concentrations ranged from 0 to 1.44 mg/L and from 0 to 4.40 g/L (0–440 mg/dL), respectively. The mean individual BAC/BrAC ratio was 2615 ± 387, 95% confidence interval 2509–2714, which is 30% higher than the legal ratio in France (2000). The correlation between both measurements was excellent: r = 0.95 (0.92–0.97). Linear regression revealed BAC = 0.026 + 1.29 (BrAC × 2000) and BAC = 0.026 + 0.99 (BrAC × 2615). Mean BAC-BrAC differences and limits of agreement were 0.49 g/L [−0.35, 1.34] (or 49 mg/dL [−35, 134] and 0.01 g/L [−0.68, 0.71] (or 1 mg/dL [−68, 71]), for the 2000 and 2615 ratios, respectively.

Conclusion

The calculated conversion coefficient provided a satisfactory determination of blood alcohol concentration. Breath alcohol testing, using appropriate BAC/BrAC conversion, different from the legal BAC/BrAC, could be a reliable alternative for routine screening and management of alcohol intoxication in the ED.     

National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors

Background: Medication errors contribute to significant morbidity, mortality, and costs to the health system. Little is known about the characteristics of Emergency Department (ED) medication errors. Study Objective: To examine the frequency, types, causes, and consequences of voluntarily reported ED medication errors in the United States. Methods: A cross-sectional study of all ED errors reported to the MEDMARX system between 2000 and 2004. MEDMARX is an anonymous, confidential, de-identified, Internet-accessible medication error-reporting program designed to allow hospitals to report, track, and share error data in a standardized format. Results: There were 13,932 medication errors from 496 EDs analyzed. The error rate was 78 reports per 100,000 visits. Physicians were responsible for 24% of errors, nurses for 54%. Errors most commonly occurred in the administration phase (36%). The most common type of error was improper dose/quantity (18%). Leading causes were not following procedure/protocol (17%), and poor communication (11%), whereas contributing factors were distractions (7.5%), emergency situations (4.1%), and workload increase (3.4%). Computerized provider order entry caused 2.5% of errors. Harm resulted in 3% of errors. Actions taken as a result of the error included informing the staff member who committed the error (26%), enhancing communication (26%), and providing additional training (12%). Patients or family members were notified about medication errors 2.7% of the time. Conclusion: ED medication errors may be a result of the acute, crowded, and fast-paced nature of care. Further research is needed to identify interventions to reduce these risks and evaluate the effectiveness of these interventions.     

急诊科护理干预对心肺脑复苏后患者近期恢复效果的影响

目的：分析研究急诊科护理干预对心肺脑复苏后患者近期恢复效果的影响。方法选择2013年7月到2014年9月到我院就诊的160例心肺脑复苏后的患者,通过随机数字表法将这160例心肺脑复苏后的患者分为两组：观察组和对照组,每组各80例心肺脑复苏后的患者。对于观察组中的心肺脑复苏后的患者采用急诊科护理干预,而对照组中的患者采取常规护理,经过一段时间后,比较两组患者的治疗效果以及两组患者的不良反应。结果通过急诊科护理干预治疗心肺脑复苏后患者的总有效率为87．50%,其中痊愈35例,有效35例,无效10例;而通过常规护理治疗心肺脑复苏后患者的总有率为73．75%,其中痊愈30例,有效29例,无效21例。通过急诊科护理干预治疗心肺脑复苏后患者的总有效率、有效率和痊愈率均高于常规护理治疗的患者,两组比较差异具有统计学意义( P<0．05)。通过急诊科护理干预治疗心肺脑复苏后患者的不良反应发生率为21．25%,其中反应迟钝3例,记忆减退4例,胸痛不适4例,抽搐6例;而通过常规护理治疗心肺脑复苏后患者的不良反应发生率为35%,其中反应迟钝4例,记忆减退6例,胸痛不适9例,抽搐10例。通过急诊科护理干预治疗心肺脑复苏后患者的不良反应率远远低于通过常规护理治疗患者,两组比较差异具有统计学意义( P<0．05)。结论急诊科护理干预对心肺脑复苏后患者近期恢复效果明显,能够明显提高有效率,降低不良反应发生率,值得在临床上广泛应用,让更多的心肺脑患者得到治疗,早日恢复健康。     

A comparison of frequent and infrequent visitors to an urban emergency department

Frequent visitors account for a high proportion of Emergency Department (ED) visits and costs. Some of these visits could be handled effectively in less expensive primary care settings. Effective interventions to redirect these patients to primary care depend on an in-depth understanding of frequent visitors and the reasons they seek care in the ED. The objective of this study was to explore the differences between frequent visitors and infrequent visitors who seek medical care in one urban ED, as a first step toward developing effective interventions to direct patients to effective sources of care. In structured interviews, we asked 69 frequent visitors and 99 infrequent visitors to an inner-city, adult ED about medical diagnoses, general health, depression, alcohol abuse, physical functioning, self-perceived social support, primary care and ED service use, payment method, satisfaction with their primary care physician, and demographic characteristics. Differences in responses between groups were compared using t-tests for continuous variables and chi-square for categorical variables. Frequent visitors were more likely than infrequent visitors to be insured by Medicaid (53% vs. 39%, respectively) and less likely to be uninsured (13% vs. 24%, respectively) or have private insurance (6% vs. 15%, respectively). They reported higher levels of stress, lower levels of social support, and worse general health status. They were much more likely to screen positive for depression (47% vs. 27%, respectively, p = 0.017). Frequent visitors were more likely to have a primary care physician (75% vs. 66%, respectively), and 45% of the frequent visitors had a primary care physician at the ED hospital compared to 23% of the infrequent visitors. These findings suggest the need to improve access to frequent visitors' primary care physicians, screen them for depression, and offer psychological and social services more aggressively. These findings may apply to other inner city EDs.     

Effect of an educational video on emergency department patient stroke knowledge

The purpose of this study was to explore whether passive watching of a stroke videotape in the Emergency Department waiting room could be an effective method for patient education. The setting was an urban, inner city teaching hospital. After providing informed consent, subjects were randomized into two arms: those watching a 12-min educational video on stroke developed by the American Stroke Association (video group) and those not undergoing an intervention (control group). Both groups were administered a 13-question quiz covering different stroke-related issues, but only the video group received this same test again after the completion of the educational program. Those enrolled were contacted after 1 month to determine knowledge retention via the same test. Immediately after watching the educational program, participants demonstrated improved knowledge of stroke-related questions, with an increase of test scores from 6.7 +/- 2.5 to 9.5 +/- 2.6 (p < 0.01). Even at the 1-month follow-up, the video group had significantly higher test scores than the control group. A stroke educational videotape improves the knowledge of this dangerous disease and may be a valuable and relatively low-cost tool for focused patient education in the Emergency Department waiting room.     

Effect of season and weather on pediatric emergency department use

It is commonly believed that emergency department (ED) use is affected by extreme weather. To test this hypothesis, data concerning use of a pediatric ED during three seasonally diverse months was analyzed in the light of Weather Bureau information concerning daily conditions during the study months. Seven measures of extreme weather were defined: 1) extreme cold (daily high temperature less than or equal to 25 degrees F); 2) extreme heat (daily high temperature greater than or equal to 88 degrees F); 3) unusual cold (winter) with departure from normal of mean temperature less than -10 degrees F; 4) unusual heat (summer) with departure from normal of mean temperature greater than 10 degrees F; 5) precipitation greater than or equal to 0.25 inches (in water-equivalent inches); 6) stormy (thunderstorm, hail, ice, or blowing snow); 7) snow-covered (greater than or equal to 6 inches of snow on the ground). Seasonal use patterns were examined and the proportion of days with each weather factor was compared with the proportion of visits on days with the factor. The data indicate 1) season has a major affect on ED use because it affects prevalence of disease and injury; 2) extremely cold and stormy conditions significant reductions in ED use of approximately 5-20%; 3) 80-95% of expected visits are made on days with very bad weather. The data indicate that weather is a minor factor in determining ED use.     

急诊科护士疼痛管理知识和态度现状的调查

目的 通过对急诊护士进行疼痛管理知识和态度问卷调查,了解急诊护士疼痛管理相关知识掌握情况及实践现状,为持续改进急性疼痛护理质量、提高急诊疼痛患者管理效果提供参考.方法 应用KASRP(疼痛管理知识和态度的调查)(2008)中文版问卷对132名急诊护士进行疼痛管理知识和态度调查,采用SPSS 17.0对收集数据进行描述性分析、方差分析.结果 急诊科护士KASRP问卷答对率在25%～65%,平均答对率为(44.65±7.85)%;答对10～26条目,平均答对(17.86±3.14)条目.不同年龄、性别及工作年限答对率差异无统计学意义;不同学历及职称答对率差异有显著性.结论 急诊科护士疼痛管理知识和态度显著缺乏,疼痛基础知识点掌握不足,疼痛管理知识与临床实践之间存在偏差,有待提高和改善.     

Effects of a general practitioner cooperative co-located with an emergency department on patient throughput

BACKGROUND: In 2013 a General Practitioner Cooperative (GPC) was introduced at the Emergency Department (ED) of our hospital. One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED. To determine the change in patient flow, we assessed the number of self-referrals, redirection of self-referrals to the GPC and back to the ED, as well as ward and ICU admission rates and length of stay of the remaining ED population.METHODS: We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands.RESULTS: More than half of our ED patients were self-referrals. At triage, 54.5% of these self-referrals were redirected to the GPC. After assessment at the GPC, 8.5% of them were referred back to the ED. The number of patients treated at the ED declined with 20.3% after the introduction of the GPC. In the remaining ED population, there was a significant increase of highly urgent patients (P<0.001), regular admissions (P<0.001), and ICU admissions (P<0.001). Despite the decline of the number of patients at the ED, the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period, a total increase of 270 hours in two months (P<0.001).CONCLUSION: Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.     

Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomized controlled trial

Objective: To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high‐risk alcohol consumption. Methods: This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high‐risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same‐day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off‐site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self‐reported daily standard drinks consumed. Analysis was by intention to treat. Results: Of 32 965 eligible patients, 10 274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. Conclusion: In the present study, neither BI nor MI was better than SC in reducing high‐risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off‐site counselling.     

The etiology and prognostic significance of cardiac troponin I elevation in unselected emergency department patients

Background: Burns are a common cause of injury presenting to the Emergency Department (ED). Several reports state that admission for and mortality from burn injury are declining. Total visits to the ED, however, have increased. Objectives: The objective of this study was to determine the number and trends over time of patients presenting to the ED for burn injury. Methods: The study was a retrospective analysis of National Hospital Ambulatory Medical Care Survey databases for 1996–2005 available from the Centers for Disease Control and Prevention. Subjects were patients with a first diagnosis of a burn. Patient weights in the database were used to obtain estimated national values. Measures used were estimated total numbers and percentages of patients by year. Trends from 1996 through 2005 were examined overall and by demographic factors and injury characteristics. Linear regression was used to evaluate trends. Results: There was a significantly decreasing trend in ED burn visits from 1996 to 2000 (614,745 to 433,681 visits), but no apparent trend for the years 2000 to 2005. Annually, about 60% of ED burn patients were male, and about half were between the ages of 19 and 44 years. Less than 5% of burns were third degree or full thickness injuries. Admissions per year were stable at 5%. The most common causes of burn injury were contact with a hot liquid and contact with a hot object, and the most common body region affected was the upper extremities (40% each year), followed by burns to the head/face/neck. Use of medications showed no trends over time. Conclusions: ED visits for burn injuries have been decreasing; however, patterns of cause, admission, and treatment show no consistent temporal change.     

产后妇女紧急避孕知识和可接受性调查

目的研究产后妇女紧急避孕知识、可接受性及使用状况。方法以美国Kai-ser Family Foundation紧急避孕调查表为基础设计问卷,对368例分娩妇女进行横断面调查。结果91.60%的研究对象听说过紧急避孕,38.10%知道紧急避孕药物使用正确时间期限,35.70%表示愿意用紧急避孕药,59.4%的人表示愿意放置宫内节育器来作为紧急避孕方法。研究对象紧急避孕知识与紧急避孕态度之间的相关系数是0.365。结论紧急避孕知识与可接受性密切相关。为了提高产后妇女紧急避孕方法的知识和可接受性,必须加强紧急避孕法的安全性、有效性以及正确使用时间的宣传。     

Effect of an evidence-based paediatric fever education program on emergency nurses' knowledge

INTRODUCTION: This study examined the effect of an educational intervention of factual knowledge on emergency nurses' knowledge and clinical decisions related to paediatric fever. METHOD: A prospective pre-test/post-test design was used. Emergency nurses' factual knowledge was measured by parallel multiple choice questions and the intervention for the study was an educational intervention consisting of two tutorials. Pre-test data were collected in early June 2005 and post-test data were collected during August 2005. RESULTS: Thirty-one emergency nurses completed the pre and post-test multiple choice questions. Emergency nurses' knowledge increased following the tutorials. Pre-test score was positively correlated with knowledge acquisition. Self-reports of independent decisions related to fever management were influenced by experience, hours of employment, level of appointment, postgraduate qualifications and pre-test score. DISCUSSION: High levels of variability in knowledge and knowledge acquisition suggest a review of undergraduate and postgraduate curricula is warranted. Although this study identified associations between independent fever management decisions and participant characteristics, further research is pivotal to better understanding these relationships.     

Effects of an emergency transfer coordination center on secondary overtriage in an emergency department

Background

Patients who cannot be stabilized at a lower-level emergency department (ED) should be transferred to an upper-level ED by emergency medical services. However, some patients are subsequently discharged after transfer without any intervention or admission, and this secondary overtriage (SO) wastes the limited resources of upper-level EDs. This study aimed to investigate whether an emergency transfer coordination center (ETCC) could reduce the risk of SO among patients who were transferred to a tertiary ED by emergency medical services.

急诊科护士灾害准备培训效果评价

目的 评估分析急诊科护士灾害准备培训效果。方法 选取268名急诊科护士作为研究对象,由具备带教急诊科护士培训资质的20名急救专家按照初级创伤救治模式进行培训,以柯氏模型为指导,采用问卷调查、笔试、情景模拟、工作坊等方法从反应层、学习层、行为层与结果层4个层面进行评价。 结果 急诊科护士对培训的总体满意度评分为（8.68±0.83）分;培训后急诊科护士的理论评分（72.51±8.24）分高于培训前（62.14±7.31）分,培训后急诊科护士的实践技能评分（74.08±6.87）分高于培训前（68.23±6.40）分,差异有统计学意义（P<0.05）。培训后急诊科护士的备灾准备度、应对准备度、灾后恢复准备度得分均高于培训前,差异有统计学意义（P<0.001）。 结论 采用初级创伤救治模式对急诊科护士进行灾害准备培训有助于提高急诊科护士的灾害准备度、灾害急救知识与专项操作技能。     

Association between ambient PM2.5 and emergency department visits for psychiatric emergency diseases

BackgroundWhether or not short-term exposure to particulate matter <2.5 μm in diameter (PM_2.5) increases the risk of psychiatric emergency diseases is unclear.MethodsThe study was performed in a metropolis from January 2015 to December 2016. The exposure was PM_2.5, and the confounders were weather (temperature and humidity) and other pollutants (PM₁₀, SO₂, CO, O₃, and NO₂). The outcomes were emergency department (ED) visits with psychiatric disease codes (F00-F99 in ICD10 codes). General additive models were used for the statistical analysis to calculate the adjusted relative risks (ARRs) and 95% confidence intervals (95% CIs) for the daily number of ED visits with a lag of 1 to 3 days following a 10 μg/m³ increase in PM_2.5.ResultsDuring the study period, a total of 67,561 ED visits for psychiatric diseases were identified and tested for association with PM_2.5. Daily ED visits for all psychiatric diseases were not associated with PM_2.5 in the model that was not adjusted for other pollutants. The ARR (95% CI) in the model adjusted for SO₂ was 1.011 (1.002–1.021) by 10 μg/m³ of PM_2.5 on Lag 1 for all psychiatric diseases (F00-F99). The ARR (95% CI) in the model adjusted for O₃ was 1.015 (1.003–1.029) by 10 μg/m³ of PM_2.5 on Lag 1 for F40-F49 (Neurotic, stress-related and somatoform disorders).ConclusionAn increase in PM_2.5 showed a significant association with an increase in ED visits for all psychiatric diseases (F00-F99) and for neurotic, stress-related and somatoform disorders (F40-F49) on lag day 1.     

Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome

Objectives

The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department–based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not.

Method

Patients who scored “>5” on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used.

Results

Discriminant function analyses indicated that “Referral made” discriminated for alcohol intake change (Wilks' λ = 0.993, P < .05); “Did the patient set goals during intervention?” and “Referral made” discriminated for alcohol dependency change (Wilks' λ = 0.940 and Wilks' λ = 0.919, P < .05, respectively). “Intention to quit” (Wilks' λ = 0.984, P < .05) discriminated for alcohol-related harm change.

Conclusions

Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.     

亲情护理对急诊患儿诊治时间及家长健康知识知晓率的影响

目的 探讨亲情护理对急诊患儿诊治时间及家长健康知识知晓率的影响.方法 将我院80例急诊发热的患儿分为观察组和对照组各40例,对照组采用常规护理,观察组在对照组的基础上采用亲情护理,比较两组患儿的护理效果.结果 观察组在急诊停留时间显著短于对照组,治疗时的配合程度、降温效果、家长健康知识的知晓率、护理满意度显著高于对照组(P＜0.05),观察组的家长心理状况显著好于对照组(P＜0.05).结论 亲情护理有利于提高护理质量,增加急诊患儿的配合度,减轻家长的焦虑感.     

急诊科实施综合护理干预对输液患者的影响研究

目的:研究急诊科实施综合护理干预对输液患者的影响。方法:将在我院急诊科接受综合护理干预后进行输液治疗的78例患者作为干预组,将同期我院急诊科未接受综合护理干预便进行输液治疗的78例患者作为对照组,对比两组输液后的焦虑情况、输液不良反应发生率及患者满意率。结果:对照组焦虑因子得分为(24.73±4.31)分,输液不良反应发生率为10.26%,患者满意率为80.77%;干预组焦虑因子得分为(12.64±7.06)分,输液不良反应发生率为1.28%,患者满意率为96.15%。两组比较有统计学意义(P<0.05,P<0.01)。结论:综合护理干预可降低患者的心理负担,提高患者的配合度,对患者的生理与心理健康均具有十分重要的积极影响作用。     

A comparison of perspectives on costs in emergency care among emergency department patients and residents

BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department (ED). We compare ED resident and patient perspectives surrounding costs in emergency care.