A survey of emergency department staff about challenges and recommendations for emergency department care of extended care facility patients

ObjectivesExtended care facility (ECF) patients who transfer to emergency departments (EDs) can pose problems when complicated health problems require extra resources. Higher numbers of older patients are projected to use EDs, so we aimed to identify problems now to implement solutions before they worsen in the future.DesignThis was a prospective survey research study.SettingED in a safety net teaching hospital in the Midwest.ParticipantsED personnel.MeasurementsConfidential, anonymous survey collected views and opinions of ED personnel about problematic issues related to emergency care of ECF residents. The survey targeted communication problems, patient satisfaction concerns, difficult characteristics of patient population, need for education, need for research—and solicited open-ended remarks.ResultsED staff reported concern about flawed communication and poor documentation from the ECF. Based on job title, divergent viewpoints were reported about pharmacological challenges and comfort levels in managing older patients in the ED. Top training priorities were special needs of older adults, detecting abuse in older adults, and specific medical and psychosocial issues associated with older adults. Increased communication among all levels of geriatric care is recommended, especially from extended care facility staff before patient arrival at the ED.ConclusionBecause population projections predict an increasing trend of older adults, health care providers must think ahead and prepare for future medical needs. This survey was an inexpensive and effective way to identify next steps. We plan to use the survey results to initiate collaboration with ED staff, EMS providers, and ECF staff to identify specific actions to improve acute care for elderly patients—for the present and the future.     

Health care reform and emergency department services

EDs are the access of last resort for many Americans, and cost-driven reform initiatives that restrict ED utilization could deter people from seeking necessary and timely medical services. The experience in Canada under universal coverage suggests that major reform could lead to a substantial increase in ED utilization, especially in view of the relative shortage of primary care physicians in the United States. Many hospitals could face short-term overcrowding problems that compromise the quality of care provided in EDs, and rural hospital EDs face specific and unique problems relative to competition and cost efficiency. Integration of emergency services into comprehensive health delivery systems under the concept of managed competition is essential to ensure access and cost-effective delivery of services. The hospital ED may well serve as an important focal point in the development of alternative physician-hospital relationships.     

The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients

There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.     

Primary care and public emergency department overcrowding.

OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations.     

Patients attending an accident and emergency department for primary medical care

An increasing number of people seek primary care at casualtyor accident and emergency departments of hospitals. A questionnairewas completed by patients attending for primary care at an Australianhospital. The study aimed to determine why patients chose thehospital fortheir medical care, whether patients triaged tothe Primary Care Unit differed from patients triaged to theCasualty section of the Accident and Emergency Department, andwhether the characteristics of patients attending at daytimediffered from those attending out of hours. There were no significantdifferences between daytime and out-of-hours attenders accordingto sex or whether born in Australia or not. More children presentedat night or at the weekend; more older people presented by day.There were more single, divorced, separated and widowed patientsamong the daytime attenders. Daytime attenders had significantlylower incomes than out-of-hours attenders, were less likelyto have a local general practitioner or full health insurance:most had a health care card and cost may have been a factorin their attendance. Out-of-hours attenders who had a localgeneral practitioner appeared to be unaware of any deputizingservices or had rejected them in favour of the hospital service.     

The relationship between hospital capacity characteristics and emergency department volumes in Korea

ObjectiveTo describe the level of emergency department (ED) volumes according to the hospital characteristics and to identify the relationship between hospital capacity characteristics and ED volumes in Korea.MethodA survey was conducted to acquire information on the ED, its’ hospital (facility, personnel, equipment), and the number of ED patients, as part of the National Emergency Medical Centers Assessment Program. Data from 106 nation-wide LEMCs were used. Multiple regression analysis was performed to determine the hospital capacity characteristics related with ED volumes.ResultsThe number of ED patients differed according to bed size, nurse staffing, residency training program, and the availability of emergency care-related equipment of the hospital. In the multiple regression analysis, the significant factors which explained the ED volumes were nurse staffing, inpatients per bed, and the population in the area where hospitals are located. The hospitals that were nurse staffing level 2, with more inpatients per bed and larger population of the service area, had more ED patients.ConclusionsWith the service area population, the ED volumes significantly related with nurse staffing and inpatients per bed. These could be used as one of criteria to designate a LEMC.     

The relationship between hospital capacity characteristics and emergency department volumes in Korea

OBJECTIVE: To describe the level of emergency department (ED) volumes according to the hospital characteristics and to identify the relationship between hospital capacity characteristics and ED volumes in Korea. METHOD: A survey was conducted to acquire information on the ED, its' hospital (facility, personnel, equipment), and the number of ED patients, as part of the National Emergency Medical Centers Assessment Program. Data from 106 nation-wide LEMCs were used. Multiple regression analysis was performed to determine the hospital capacity characteristics related with ED volumes. RESULTS: The number of ED patients differed according to bed size, nurse staffing, residency training program, and the availability of emergency care-related equipment of the hospital. In the multiple regression analysis, the significant factors which explained the ED volumes were nurse staffing, inpatients per bed, and the population in the area where hospitals are located. The hospitals that were nurse staffing level 2, with more inpatients per bed and larger population of the service area, had more ED patients. CONCLUSIONS: With the service area population, the ED volumes significantly related with nurse staffing and inpatients per bed. These could be used as one of criteria to designate a LEMC.     

Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada

Inconsistent results have been obtained from studies that have examined the relationship between air pollution and hospital visits for stroke. We undertook a time-stratified case-crossover study to evaluate associations between outdoor air pollution and emergency department visits for stroke among the elderly according to stroke type, season, and sex. Analyses are based on a total of 12,422 stroke visits among those 65 years of age and older in Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for SO₂, NO₂, PM_2.5, PM₁₀, CO and O₃ were estimated using data from fixed-site monitoring stations. Particulate matter data were only available from 1998 onwards. Conditional logistic regression was used to estimate the odds ratios (ORs) and their 95% confidence intervals in relation to an increase in the interquartile range (IQR) of each pollutant. ORs were adjusted for the effects of temperature and relative humidity. We found no association between outdoor measures of air pollution and all stroke visits. In contrast, elevated risks were observed between levels of air pollution and acute ischemic stroke between April and September. During this season, the ORs associated with an increase in the IQR of the 3-day average for CO and NO₂ were 1.32 (95% CI = 1.09–1.60) and 1.26 (95% CI = 1.09–1.46), respectively. CO exposures in the same season, lagged 1 day, were associated with an increased risk of hemorrhagic stroke with ORs was 1.20 (95% CI = 1.00–1.43). Our results suggest it is possible that vehicular traffic, which produces increased levels of NO₂ and CO, contributes to an increased incidence of emergency department visits for stroke.     

急诊创新绿色通道对急性缺血性脑卒中静脉溶栓治疗患者的抢救效果分析

目的 旨在探讨急性缺血性脑卒中静脉溶栓治疗中的急诊创新绿色通道对患者抢救效果的影响。方法 选取了2020年1月—2021年12月,本院收治的100例急性缺血性脑卒中静脉溶栓治疗患者作为研究对象。按照随机数字表法,随机将患者分为对照组(n=50)和观察组(n=50),观察组进行急诊创新绿色通道干预,对照组进行常规急诊通道干预,对比2组抢救效果、不同诊疗时间指标、2组神经损伤严重程度等。结果 观察组抢救室平均停留时间、完善CT时间、到达科室时间和急诊绿色通道救治时间比对照组短(2组差值分别为18.76±0.87、2.92±0.63、3.82±0.15、23.00±1.42),差异有统计学意义(t=8.941,2.665,4.248,8.545,P<0.001,=0.009,<0.001,<0.001);干预后2组中枢神经损伤严重程度评分观察组低于对照组(2组差值分别为6 h时为2.49±0.08、1 d时为3.22±0.35、1周时为2.36±0.04),差异有统计学意义(F_组间=6.132,F_时间=4.983,F_交互...     

Resources and capacity of emergency trauma care services in Peru

The objectives of this study were to evaluate the resources and capacity of emergency trauma care services in three Peruvian cities using the WHO report Guidelines for Essential Trauma Care. This was a cross-sectional study in eight public and private healthcare facilities in Lima, Ayacucho, and Pucallpa. Semi-structured questionnaires were applied to the heads of emergency departments with managerial responsibility for resources and capabilities. Considering the profiles and volume of care in each emergency service, most respondents in all three cities classified their currently available resources as inadequate. Comparison of the health facilities showed a shortage in public services and in the provinces (Ayacucho and Pucallpa). There was a widespread perception that both human and physical resources were insufficient, especially in public healthcare facilities and in the provinces.     

Prehospital care of acute myocardial infarction: a review.

Each year more than 1 million people in the United States suffer from acute myocardial infarction (MI) with most of the deaths occurring within hours of symptom onset. Over the last 25 years, different prehospital systems have evolved throughout the world which allow early cardiac monitoring and treatment of acute MI patients. Thrombolytic therapy in acute MI has been shown to decrease mortality and preserve left ventricular function when administered early after onset of symptoms. The potential role of Emergency Medical Services or Mobile Coronary Care Units in achieving early thrombolysis is under investigation. Several studies of prehospital interventions to achieve early thrombolysis are reviewed. The use of thrombolytics by prehospital personnel has been found to be feasible, safe, and effective in reducing time delays. However, whether this translates into clinical benefit remains to be seen.     

Patient management in the emergency department by advanced care paramedics

We describe an emergency department process using Advanced Care Paramedics in the management of patients identified as ambulatory and low acuity, or those able to be managed without an emergency nurse. Patients streamed in this way had shorter stays than other emergency patients, without affecting the care of the latter. The process was associated with improved patient flow indicators in spite of an increased patient burden.     

116例急性卒中患者院前流行病学特征

目的探讨镇江市急救中心救治的116例急性卒中患者的临床特征。 方法回顾性分析2019年1月1日至3月31日镇江市急救中心收治的116例脑卒中患者的病历资料，其中男性73例，女性43例；年龄23～96岁，平均(55.1±14.0)岁。分析内容包括患者基本特征、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、送达医院时的生命体征等。 结果青年脑卒中(年龄<45岁)占全部患者的22.4%，65岁以下患者占78.4%。卒中患者以男性居多(62.9%)，城市居多(72.4%)。从卒中症状开始到到达医院的时间平均为27 h(范围为0.5～72 h)。40例患者(34.5%)在症状出现后4.5 h内(窗口期)到达有溶栓能力的医院。患者总体NIHSS为(15.71±7.52)分，出血性卒中患者[(17.54±7.54)分]高于缺血性卒中患者[(14±7.15)分](P<0.05)。所有脑卒中患者入院平均GCS评分为(12.12±3.35)分，缺血性卒中为(13.07±2.56)分，出血性卒中为[(11.11±3.80)分](P<0.05)。 结论镇江市急救中心院前救治的卒中患者以65岁以下患者为主，男性居多，尽管患者意识水平尚可，但普遍病情较重，而且仅约1/3患者能短时间到达医院。因此，社会、媒体和医疗机构应积极的宣传，使人们提高对危险因素和卒中的认识。急救中心也应进一步提升相应的救治能力。     

急诊室急性胸痛患者的护理方法分析

目的:分析急诊室急性胸痛患者的护理方法.方法:根据数字随机原则将80例急性胸痛患者分成对照组和实验组,每组均为40例;对照组患者选择常规护理干预,实验组患者则选择针对性护理干预,观察分析两组患者的护理效果.结果:实验组患者的护理满意度、并发症发生率均显著优于对照组患者,两者比较差异有统计学意义(P<0.05).结论:针对病因为急诊室急性胸痛患者提供有针对性的护理干预,能让并发症发生率显著降低,让患者满意度提高,具有临床应用和推广价值.     

Thrombolysis and its implications in the management of stroke in the accident and emergency department

OBJECTIVES: Examination of initial management of stroke patients in the emergency setting to assess feasibility of thrombolysis for acute ischaemic stroke. METHODS: Retrospective analysis of all patients presenting with a clinical diagnosis of stroke over a two month period. Exclusion criteria for thrombolysis were applied to assess the number of patients that would potentially have been eligible for thrombolysis. RESULTS: Of 94 patients identified with clinical stroke, only 57 (60.6%) had a CT scan; 23 (24.4%) were confirmed as having had an acute ischaemic stroke. Mean delay in scanning was 2.2 days (range 0-15 days). Even if all patients had presented and been scanned within three hours (as required for thrombolysis), only six (6.4%) patients would have been eligible for thrombolysis. CONCLUSIONS: The great majority of patients presenting with clinical stroke do not fulfill the criteria for thrombolysis. Current practice involves significant delays in CT scanning, which has implications for resource structuring should thrombolysis become widely available.     

院前急救护理对急性心肌梗死患者院前急救的影响

目的:探讨院前急救护理对急性心肌梗死患者院前急救的应用效果.方法:选取我院中心急救车送入医院的急性心肌梗死患者64例作为观察组,由家属直接送入医院的患者64例作为对照组.对照组实施常规护理方法,观察组实施院前急救护理措施,分析实施前后患者的急诊抢救时间、患者存活率及住院时间.结果:与对照组相比较,患者的存活率显著高于对照组,差异具有统计学意义(P<0.05).结论:院前急救护理值得临床推广及应用.