Non-urgent visits to a hospital emergency department in Italy

The purpose of this study was to determine the extent of non-urgent visits and the effect of different characteristics on such visits to one public hospital emergency department located in Catanzaro, Italy. Of 581 patients aged 15 years and older who were registered for care in the emergency department, 40 were excluded from the study as they were too ill or distressed. The survey questionnaire included questions about the patients' demographic and socio-economic characteristics, distance from home to hospital, usual health status and health status at the time of presentation to the emergency department. Of the 541 patients who agreed to participate, 19.6% of patients, according to the judgement of two observers, had non-urgent conditions. The results of the multiple logistic regression analysis showed that among all variables tested, age and sex were significant predisposing factors for utilization of the emergency department for non-urgent visits. Indeed, the odds of presenting for non-urgent care were significantly higher if patients were younger and female. Moreover, the odds of requiring non-urgent care were significantly higher in patients who present to the emergency department without medical referral and in patients who present with problems of longer duration. The most frequent reason given by patients for their visit to the emergency department was that they felt their problem was an emergency. Further investigations are necessary to evaluate the use of primary care since closer co-operation within the healthcare organization system may provide a more responsive service.     

Nonemergency visits to hospital emergency rooms: a comparison of blacks and whites

Both blacks and whites go to hospital emergency rooms for nonemergency health problems. Age, marital status, and health conditions are significant sociodemographic determinants for blacks' visits on these occasions, while those for whites include sex, age, education, insurance, employment status, region of residence, and health conditions. Despite the significant differences in determinants, similar influences bear on the two groups' decision to utilize medical services generally. Discrete analyses are still needed of cultural and interracial variation affecting the use of health facilities, together with intensive assessment of community characteristics in which the facilities are located, especially among black populations.     

Public hospital emergency department visits due to burns in Brazil, 2009

The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers.     

Asthma attack periodicity: a study of hospital emergency visits in Vancouver

Attendances at the emergency departments of the nine acute care hospitals serving the Vancouver region, with a population of just under a million people, were recorded from July 1, 1984 to October 31, 1986. Of about 25,500 visits a month, 2.7% were for respiratory conditions; and of these, 41.3% were for asthma. Data from 11 air monitoring stations were also tabulated on a daily basis, giving mean maximal hourly values for SO2, NO2, and O3; daily aerosol sulfate measurements from one station were also analyzed, together with daily temperature data and measurements of the coefficient of haze. In 3 consecutive years, a peak in asthma attendances was noted, starting in the last week of September, and continuing for 3 weeks. In these periods, weekly visits for asthma reached 130 patients; during the rest of the year, the weekly visits for asthma varied between 30 and 90. This peak affected children and adults between the ages of 15 and 60, but no increase was seen in those over 60 years. Although pollution levels increased sharply in the fall, a day-by-day analysis showed that the rise in asthma attendances preceded the increase in NO chi and SO2 levels for the region, expressed as the mean of the hourly maxima across all stations. It seems unlikely that a specific pollen is responsible for this, or that house mite replication is the cause. Soya beans are not shipped out of Vancouver. The cause of the peak has not been identified. Variations in emergency visits by day of the week have been recorded; in children and in those aged 15-60, more visits occur on Sundays than on other days, but this does not occur in those over 60. There is no significant variation in environmental data by day of the week. Intercorrelations between environmental variables and emergency visits have been calculated separately for the periods May 1 to October 31, and November 1 to April 31. SO2, NO2, and SO4 are strongly intercorrelated in both periods; ozone is strongly related to temperature, but less strongly correlated to sulfate than is the case in Southern Ontario. In summer, total emergency visits (but not respiratory visits) are strongly correlated with temperature in all age groups (the hotter the day, the more visits occur); but respiratory visits are not related to temperature, ozone, or NO2 levels. However, in the 15-60 age group, asthma and respiratory visits are correlated in summer with SO2 and SO4 levels (P = less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)     

我院门急诊患者一日就诊情况的统计分析

目的 为掌握我市在实施基本医疗保险制度改革以前城市大医院门急诊患者主诊的基本情况。方法 采用剖面调查问郑的方式对门急诊患者的医疗保障方式、患者来源、患者转诊以及医生评价4个方面进行调查研究。结果 现阶段城市大医院门急诊的特点是有较高的医疗需求和吸引力，拥有覆盖面较广的病人来源；具有较强的临床综合优势。同时，在实施基本医疗保险制度改革以前，现存的医疗保障体系正处于过渡转型时期，种类较多；医疗保障覆盖面相对较窄，自费病人比例较高。结论 应积极推进医疗保险制度改革，建立适合我国国情的区域卫生规划，扩大社区医疗保健功能。     

Air pollution and unscheduled hospital outpatient and emergency room visits.

We conducted a time-series analysis of daily hospital visits and air pollution data to assess acute effects of air pollution on daily unscheduled outpatient visits to internal medicine, pediatric, and emergency departments in the No. 3 Affiliated Hospital of Beijing Medical University in Beijing, China. Sulfur dioxide was marginally significantly associated with total outpatient visits (beta = 41.5, SE = 24.2) and significantly associated with internal medicine (beta = 14.6, SE = 6.7), pediatric (beta = 12.7, SE = 3.7), and emergency room visits (beta = 6.8, SE = 2.7). Total suspended particulates (TSP) was a significant predictor for total outpatient (beta = 21.1, SE = 7.7) and pediatric visits (beta = 3.4, SE = 1.3) and a marginally significant predictor of internal medicine visits (beta = 4.2, SE = 2.2). In a season-specific analysis, SO2 was a significant predictor for total hospital outpatient visits in summer, although the mean daily SO2 concentration was only 17 micrograms/m3 (maximum = 51 micrograms/m3). In winter, SO2 was significantly associated with internal medicine, pediatric, and emergency room visits, and TSP was associated with total outpatient visits. This study suggests an exposure-response relationship between TSP and SO2 and hospital outpatient visits, both at high air pollution levels and at levels well below air quality standards recommended by the World Health Organization.     

A method for ascertaining the seasonal pattern of hospital emergency department visits

A suitable method is set forth in this study for isolating and describing high frequency seasonal variations which may occur in some sets of time series in the healthcare setting. If the simultaneous presence of seasonal variations within a day, a week and a year is not taken into account, the estimates of seasonal behaviours may be noticeably distorted and the decisions made by those in charge of managing healthcare services based thereupon might be erroneous. The proposed procedure, based upon taking simultaneous periodic changes jointly into consideration is applied to an hourly series of patients visiting an hospital emergency room in Tenerife. The results obtained indicate that the most frequent visits take place in February and March, Mondays being the days on which the greatest demand occurs and the early morning hours of the day showing the minimum demands. A long-term growth is also observed. And, above all, the proposed method is shown to provide some advantages over other approaches in which each one of the seasonal variations is estimated as if the others do not exist.     

Association between hospital emergency visits for asthma and air pollution in Valencia,Spain

OBJECTIVE: To assess the short term effect of concentrations of black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) in ambient air on emergency room visits for asthma in the city of Valencia, Spain during the period 1994-5. METHODS: Ecological study with time series data and application of Poisson regression. Associations between number of daily emergency visits in a city''s hospital and concentrations of air pollutants were analysed taking into account potential confounding factors by the standardised protocol of the air pollution and health: a European approach (APHEA) project. RESULTS: Mean (range) daily number of emergency room visits for asthma was 1 (0-5). Concentrations of all pollutants studied remained within current air quality standards. The association between an increase of 10 micrograms/m3 in ambient air pollution and asthma, measured as a relative risk (RR) of emergency visits, was significant for NO2 24 hour mean (lag 0, RR 1.076, 95% confidence interval (95% CI) 1.020 to 1.134), NO2 hour maximum (lag 0, RR 1.037, 95% CI 1.008 to 1.066), and O3 hour maximum (lag 1, RR 1.063, CI 95% 1.014 to 1.114). The association was not significant for SO2 or for black smoke during the period analysed. The effects were not significantly different for the time of year, cold months (November to April), or warm months (May to October). CONCLUSIONS: Current concentrations of ambient air pollution in Valencia are significantly associated with emergency room visits for asthma. This association is high and more consistent for NO2 and O3 than for particulate matter and SO2 (classic pollutants).       

气温变化与心脑血管疾病急诊关系的病例交叉研究

目的 探讨北京市日平均气温与心脑血管疾病急诊(ICD-10:I00～I99)的关系,研究气温变化对心脑血管疾病的影响.方法 收集北京大学第三医院急诊科心脑血管疾病急诊资料、北京市气象资料和北京市大气污染物数据,应用时间分层的病例交叉设计研究方法分析春季(3-5月)、夏季(6-8月)、秋季(9-11月)、冬季(12-2月)日平均气温与心脑血管疾病急诊的关系.结果 在控制二氧化硫(SO2)、二氧化氮(NO2)及大气可吸入颗粒物(PM10)影响的情况下,春季、夏季、秋季、冬季当日平均气温对心脑血管疾病急诊的影响最大,平均气温每升高1℃与心脑血管疾病急诊的OR值分别为1.282(95%CI:1.250 ～1.315)、1.027(95% CI:1.001～1.055)、0.661(95% CI:0.637～0.687)、0.960(95%CI:0.937～0.984),关联有统计学意义(P<0.05).当同时调整相对湿度、风速、大气压强的影响时,春季、夏季、秋季、冬季平均气温与心脑血管疾病急诊的OR值分别为1.423(95%CI:1.377～1.471)、1.082(95%CI:1.041～1.124)、0.633(95%CI:0.607～0.660)、0.971(95%CI:0.944～1.000).关联有统计学意义(P<0.05).结论 春季、夏季日平均气温升高可以导致心脑血管疾病急诊人次增加,说明春夏季气温升高对心脑血管疾病患者是危险因素,应注意防暑;秋季、冬季气温升高可以导致心脑血管疾病急诊减少,说明秋冬季气温升高对心脑血管疾病患者是保护性因素,应注意保暖.     

Involuntary return to a psychiatric emergency service within twelve months

OBJECTIVE: Under managed care, there is pressure to shorten hospital stays. Yet, previous investigations have shown longer hospitalizations following a psychiatric emergency service (PES) evaluation reduce recidivism. This study examines the relationship between post-PES hospitalization, patient characteristics and involuntary PES return within 12 months. It is done in a context where average duration of post-PES hospitalizations are 6 days, approximately 1/4 the duration of previous studies reporting positive effects of such hospitalization. METHOD: Structured observations of PES evaluations of 417 patients were completed at 7 California county general hospitals. Follow-ups were conducted at 12 months after initial evaluation. Study objectives are evaluated using multivariate modeling. RESULTS: Subsequent to the initial evaluation, 121 of the 417 patients (29.0%) were involuntarily returned to the PES. The likelihood of involuntary return was increased by a psychotic diagnosis and the seriousness of initial clinical presentations on the TRIAD dangerousness criterion measure. Having insurance also increased the likelihood of involuntary return. CONCLUSIONS: As the patient's initial PES condition was found to be the best predictor of involuntary return and duration of post-PES hospitalization seemed to lose its prophylactic effect, it seems we have gone too far in reducing lengths of inpatient stays. We may have lost sight of the crucial role of this setting in stopping the revolving door and insuring appropriate care.     

长沙市气温变化与急性脑血管疾病急诊关系的病例交叉研究

目的 探讨长沙市日均气温变化与急性脑血管疾病急诊的相关性.方法 收集2008-2009年长沙市每日急性脑血管疾病急诊数据及相关气象和大气污染数据,运用季节分层的病例交叉设计分析不同季节日均气温变化对总急性脑血管疾病及主要亚型[脑出血、脑梗死和短暂性脑缺血发作(TIA)]的影响.结果 同时控制相对湿度、气压和风速的多气象因素模型分析显示,春季日均气温每升高1℃,脑出血、脑梗死、TIA和总急性脑血管疾病急诊的OR值分别为1.278 (95％CI:1.045～ 1.563)、1.223(95％CI:1.056～1.416)、1.318(95％CI:1.099～1.581)和1.239(95％CI:1.085～1.414),关联均有统计学意义(P＜0.05);夏季日均气温每升高1℃,脑梗死和总急性脑血管疾病急诊的OR值为1.201 (95％CI:1.006～1.434)和1.179(95％CI:1.002～1.387),关联有统计学意义(P＜0.05),脑出血和TIA急诊的OR值大于1,但关联无统计学意义;秋季日均气温每升高1℃,脑出血、脑梗死、TIA和总急性脑血管疾病急诊的OR值分别为0.803 (95％CI:0.683～0.944)、0.765(95％CI:0.664～0.882)、0.794(95％CI:0.671～0.940)和0.792(95％CI:0.699～0.898),关联均有统计学意义(P＜0.05);冬季日均气温变化与上述疾病的发病关联均无统计学意义.结论 长沙地区春季气温升高是脑出血、脑梗死、TIA和总急性脑血管疾病的危险因素,夏季气温升高是脑梗死和总急性脑血管疾病的危险因素,秋季气温下降是脑出血、脑梗死、TIA和总急性脑血管疾病的危险因素.     

Gaseous air pollution and emergency hospital visits for hypertension in Beijing,China: a time-stratified case-crossover study

Background  

A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension.     

大气污染物与呼吸系统疾病急诊就诊关系的病例交叉研究

目的 分析大气污染急性暴露对呼吸系统疾病急诊人次的影响.方法 收集2004年1月1日至2005年12月31日北京大学第三医院急诊科呼吸系统疾病急诊资料和北京市环境监测中心大气污染物数据,应用时间分层的病例交叉设计研究方法进行数据分析,同时比较单向回顾性对照设计和双向对照设计研究结果的差异.结果 在调整气象因素并采用单向回顾性(多污染物)模型中,无滞后大气可吸入颗粒物(PM10)、二氧化硫(SO2)、滞后2 d二氧化氮(NO2)日平均浓度每增加10 μg/m3,呼吸系统疾病总急诊的OR值(95%CI)分别为1.010(1.005～1.014)、1.010(1.001～1.018)、0.996(0.983～1.009);双向对称性(多污染物)模型中,其相应OR值(95%CI)分别为1.002(0.998～1.005)、1.011(1.003～1.018)、1.012(1.001～1.022).采用不同对照选择方案,病例交叉设计的研究结果有变化.结论 区域内大气污染物暴露对居民呼吸系统疾病急诊人次有急性效应.     

主动沟通及转科后回访对ICU护理质量的影响

目的:探究主动沟通与转科后回访对ICU护理质量的影响.方法:选取本院2015年2月2016年10月通过ICU成功抢救病情改善到本院住院科室持续治疗的280例患者,根据入院先后顺序分为2组,对照组予以常规护理沟通,观察组在患者入科至转科整个过程中进行主动护理沟通.并对护理满意度、沟通能力、护理投诉、基础护理不良事件发生率、患者重返率予以比较.结果:观察组满意度、沟通能力均高于对照组(P<0.05),观察组基础护理不良事件、患者重返率与护理投诉服务均比对照组低(P<0.05).结论:主动沟通与转科后回访可提高ICU护理质量,提升患者与家属对护理工作的满意度.