The influence of crowding on clinical practice in the emergency department

Background

This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED).

External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP)

ObjectiveWe validated prior emergency department (ED) assessments of the chest pain score accelerated diagnostic pathway (EDACS-ADP) in Korean patients. This score is designed to discriminate patients at a low risk of a major adverse cardiac event (MACE) from those with a potentially more serious condition.MethodsWe retrospectively evaluated 1273 patients who had presented at our ED with chest pain or symptoms of a suspected coronary artery disease and who underwent coronary computed tomographic angiography from January 2017 to December 2018. These cases had been classified as low or high risk using the EDACS-ADP. The primary outcome was a MACE onset within 30 days of presentation.ResultsOf the total study patients, 448 (35.2%) were classified as low risk by the EDACS-ADP and 5 cases (1.1%) of MACE arose. Overall, 221 patients in the study population (17.3%) developed a MACE. The sensitivity, and negative predictive values of the EDACS-ADP were 97.7% (95% CI 94.8–99.3), and 98.9% (97.4–99.5), respectively.ConclusionThe sensitivity and negative predictive values for the EDACS-ADP were high in Korean patients presenting at the ED. However, the MACE rate among low-risk patients is higher than that considered acceptable by the majority of ED physicians for patients that are to be discharged without further evaluation. Further studies may be warranted for the successful application of the EDACS-ADP.     

对急诊科护士进行专业英语培训的探讨

目的探讨提高急诊科护士专业英语水平的有效培训模式。方法对60名急诊科护士进行为期2年的专业英语培训,自学为主、结合临床工作,注意听、说、读、写、译英语综合运用能力的训练。应用自行设计的问卷和试卷,对培训情况进行调查分析。结果86.7%的急诊科护士认为有必要进行专业英语培训,培训后护士的专业英语运用能力及相关的工作能力显著提高,培训前后英语测试的各项成绩差异均具有统计学意义。结论应重视急诊科护士的专业英语掌握情况,根据实际情况采用合适的培训方法,可有效提高其专业英语水平及相关的工作能力,促进急救护理事业的发展。     

CK-MB isoforms for early risk stratification of emergency department patients

The potential clinical utility of single sample CK-MB isoforms measurement for early risk stratification of Emergency Department (ED) patients with possible myocardial ischemia was evaluated among 405 patients presenting to two urban EDs. Clinical and serologic data were prospectively collected and the occurrence of adverse events (AEs) and myocardial infarction (MI) during the 14-day outcome period was recorded and utilized to calculate and compare relative risks (RR) and predictive values of isoforms and CK-MB alone. Among the 405 patients, 67 accrued 105 AEs. Both isoforms and CK-MB alone were predictive of AEs with RR of 3.32 (2.09, 5.27) and 6.28 (4.64, 8.52), respectively. Isoforms had higher sensitivity for AEs compared to CK-MB (65.7% [54.3, 77.0] vs. 14.9% [6.4, 23.5]; p<0.01) but lower specificity (69.2% [64.3, 74.2] vs. 99.7% [99.1,100.0]; p<0.01). Isoforms’ superior sensitivity allowed identification of many high risk patients missed by CK-MB alone. Further, for the prediction of MI, isoforms had superior diagnostic sensitivity and equivalent specificity. This investigation supports the emergency department use of early, single sample CK-MB isoform testing.     

Procalcitonin as a diagnostic marker for sepsis/septic shock in the emergency department; a study based on Sepsis-3 definition

Introduction

The recent definition of sepsis was modified based on a scoring system focused on organ failure (Sepsis-3). It would be a time-consuming process to detect the sepsis patient using Sepsis-3. Procalcitonin (PCT) is a well-known biomarker for diagnosing sepsis/septic shock and monitoring the efficacy of treatment. We conducted a study to verify the predictability of PCT for diagnosing sepsis based on Sepsis-3 definition.

急诊高血钾患者描述性流行病学研究

目的:描述急诊患者高血钾的发生率、诊断率、治疗率、治疗模式和复查率。方法:利用全军合理用药监测网数据管理中心数据库,提取并关联2015年至2017年急诊血钾检测、诊断和用药记录。纳入至少有一次血钾检测记录的18岁以上急诊患者。对如下指标进行了描述性分析：所有患者以及慢性肾脏病、心力衰竭、糖尿病和高血压患者中高血钾发生率...     

Headache patients in the emergency department of a Greek tertiary care hospital

The aim of this study was to record the demographic and epidemiological data on adult patients with headache who attend the emergency department (ED) and the diagnoses that made by the neurologists in the ED of a tertiary care hospital in metropolitan Thessaloniki (Greece). In an open prospective study, demographic and epidemiological data were collected on all patients who reported headache (as chief complaint or not) and presented to the ED of Papageorgiou Hospital between August 2007 and July 2008. Headache patients accounted for 1.3% of all ED patients and for 15.5% of patients primarily referred to the ED neurologist. Tension type headache was the most frequent diagnosis, followed by secondary headaches and migraine. The large number of patients without final ED diagnosis and ward admission for further evaluation sheds a light on the immense workload of Greek ED physicians. Furthermore, we found evidence for the misuse of Emergency Medical Services by chronic headache patients. These findings indicate shortcomings in the pre-hospital (primary care) management of headache patients in the Greek National Health System to an extent unreported so far.     

Rate of patients at elevated risk of opioid overdose visiting the emergency department

Objective

To determine the rate of patients visiting the emergency department who are at risk of opioid overdose.

Current European data collection on emergency department presentations with acute recreational drug toxicity: Gaps and national variations

Background. The number of new (novel) psychoactive substances (NPS) available in the illegal market is increasing; however, current monitoring of the drug situation in Europe focuses mainly on classical drugs of abuse, with limited emphasis on clinical presentation in the emergency department (ED). The European Drug Emergencies Network (Euro-DEN) is a European Commission-funded project that aims to improve the knowledge of acute drug toxicity of both classical recreational drugs and NPS. As a baseline for this project, we performed a study to establish which data are currently being collected and reported in Europe on ED presentations with acute toxicity related to NPS and classical drugs of abuse. Methods. We used a three-pronged approach to identify any systematic collection of data on NPS toxicity in Europe by i) performing a literature search, ii) utilising an online survey of the European Monitoring Centre for Drugs and Drug Addiction Re seau Europe en d’Information sur les Drogues et les Toxicomanies national focal points and iii) exploiting the knowledge and resources of the Euro-DEN network members. Results. The literature search revealed 21 papers appropriate for assessment, but only one described a systematic collection of clinical data on NPS. Twenty-seven of thirty countries responded to the online survey. More than half of all the countries (52%) did not perform any registration at all of such data, 37% collected systematic clinical data on NPS at a national level, while 44% collected data on classical drugs. A few examples for good practice of systematic collection of clinical data on ED presentations due to acute toxicity were identified. Conclusion. The systematic collection of data on ED presentation of toxicity related to NPS and classical drugs in Europe is scarce; the existing collection is limited to single centres, single countries, groups of patients or not focused on novel drugs; the collection of data is highly variable between the different countries. Euro-DEN, a European Commission funded project, aims at closing some of these gaps.     

护理风险的前瞻性管理和全程动态管理在急诊科病人抢救中的应用

目的 探讨护理风险的前瞻性管理和全程动态管理在急诊科的应用效果.方法 通过识别和分析急诊科在抢救病人中存在和潜在的护理风险,对护理风险实施前瞻性管理和全程动态管理.结果 急诊科护理质量和病人对急诊科工作满意度明显提高,病人投诉及护理差错发生率大为下降.结论 护理风险的前瞻性管理,是降低急诊科护理风险的根本保障;护理风险的全程动态管理,是降低急诊科护理风险的重要手段.     

Appropriateness of point-of-care testing (POCT) in an emergency department

BACKGROUND: Acute coronary syndrome is a major cause of death, morbidity and access in emergency departments (ED). METHODS: We evaluated a point-of-care testing (POCT) for the determinations of cardiac markers in an emergency department (ED), defining the clinical efficiency (management of patient with chest pain) and economic effectiveness (rationalization of preanalytical phase) related to data of Core Lab. RESULTS: The results of analytical performances showed a good correlation (cTnI r(2)=0.89, myoglobin r(2)=0.84, CK-MB r(2)=0.9) between POCT and Core Lab and a significant decrease of the turn around time (TAT): difference of medians=-54 min, 95% CI from -48 to -60 min. CONCLUSIONS: Our data confirmed that the accurate utilization of POCT in the ED assumes an effective triage of patient with chest pain and the improvement of preanalytical phase out of the laboratory (delivery of specimens) and within the laboratory reception, centrifugation. However, efficiency must be linked to methodological and quality control of the Core Lab, mainly through connectivity.     

Recognition of psychological and cognitive impairments in the emergency department

Ninety-six patients presenting to a university hospital emergency department were screened before triage for psychological symptoms or cognitive impairment using the General Health Questionnaire (GHQ) and Mini-Mental State examination (MMS). Charts were reviewed for demographic information and emergency physicians' recognition of psychological symptoms or cognitive dysfunction. Of the patients studied, 38% had positive results on the GHQ, and 18% had positive results on the MMS. Psychological symptoms or cognitive impairments were recognized by the emergency physicians in only 8% of those with positive GHQ results and 6% of those with positive MMS results. The usefulness of screening measures for psychological symptoms and cognitive impairment of emergency department patients is discussed.     

分组管理在急诊科护理工作中的应用

目的 探讨急诊科实施分组管理的护理效果.方法 根据我院急诊科情况和护士的知识、技能特点,按照急诊种类对31名护士进行分组管理.随机抽样调查方法调查急诊医生对诊治过程中护理工作及患者的满意度,对比实施分科分组前后护理人员的专科业务考核情况,评价分组前后的护理效果.结果 实施分组管理后,急诊科医生及患者对急诊科护理人员工作的满意度显著增高(P＜0.05),护理人员专科考核的得分显著高于分组前(P＜0.001).结论 实施分组管理有利于急诊科护理质量、护士整体素质的提高,有利于急诊科机能的优化发挥,值得推广应用.     

Describing physiotherapy interventions in an emergency department setting: an observational pilot study

Physiotherapy interventions are provided to patients within Australian emergency departments in selected settings. By describing physiotherapy in the emergency department a contribution is made to understanding the shift in professional roles in emergency department settings. Using an intensive 5-day observational, single case design two key data sources were used: researcher observations and features of patient interventions provided by the emergency department (ED) physiotherapist outlined on a purposefully designed data collection sheet. Twenty patients (10 male, 10 female) were observed to have ED physiotherapy management during the data collection period. Physiotherapy interventions were targeted towards relieving pain, improving mobility, increasing joint range of motion and assisting with discharge planning of these patients. The interventions included educating patients about their conditions, providing gait aids, assisting with patient mobility and transfers, and liaising with medical, nursing and pharmacy staff for medication reviews and discharge planning requirements. Physiotherapy can assist with assessing and managing patients to contribute to reducing unnecessary hospital admissions from the ED. Interventions involve targeting features that would normally impede discharge of patients, such as reduced mobility, poor pain management and inadequate community or environmental supports, through interdisciplinary liaison with medical, nursing and allied health ED staff.     

Validation of different pediatric triage systems in the emergency department

BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.     

Meeting the needs of people with a learning disability in the emergency department

Nurses in the emergency department will regularly encounter individuals with a learning disability in their day to day work. Admission to hospital and especially the emergency department can be very problematic for people with a learning disability. For a number of reasons the health, safety and welfare of this group of patients may be seriously compromised. An awareness of the risks associated with hospital care for these patients, along with an understanding of their specific needs, will help to minimise the potential for problems to occur.