Psychiatry in the emergency department: factors associated with treatment and disposition

Patients with psychiatric problems present difficult treatment and dispositional decisions to physicians in general hospital emergency departments (ED). We studied the relationships between the psychosocial characteristics of patients given psychiatric diagnoses and clinical decisions made by nonpsychiatrists and psychiatrists in our ED. Decisions concerning psychiatric consultation in the ED, dispositional decisions (admission, discharge), and referral for psychiatric outpatient care for patients discharged were reviewed for 246 patients. The relationships between decisions and 13 indicators of patients' psychosocial characteristics were evaluated by use of stepwise logistic regression techniques. Psychiatric-related variables (severity of symptoms, history of psychiatric hospitalization or outpatient treatment, and psychotropic medications at entry to the ED) were associated with decisions made by both psychiatrists and nonpsychiatrists. However, nonpsychiatric variables including patient's age, "rudeness," diffuseness of medical complaints, time of day, and month of presentation also were related to decisions. Practitioners should be sensitive to social factors that affect their decisions about psychiatric patients.     

Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay

BACKGROUND: The study aimed to compare the time to overall length of stay (LOS) for patients who underwent point-of-care ultrasound (POCUS) versus radiology department ultrasound (RDUS).METHODS: This was a prospective study on a convenience sample of patients who required pelvic ultrasound imaging as part of their emergency department (ED) assessment.RESULTS: We enrolled a total of 194 patients who were on average 32 years-old. Ninety-eight (51%) patients were pregnant (<20 weeks). Time to completion of RDUS was 66 minutes longer than POCUS (95%CI 60-73, P<0.01). Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay (LOS) (95%CI 66-173, P<0.01)CONCLUSION: In patients who require pelvic ultrasound as part of their diagnostic evaluation, POCUS resulted in a significant decrease in time to ultrasound and ED LOS.     

Diagnostic approach to constipation impacts pediatric emergency department disposition

Objectives

Constipation is a common cause of abdominal pain in children presenting to the emergency department (ED). The objectives of this study were to determine the diagnostic evaluation undertaken for constipation and to assess the association of the evaluation with final ED disposition.

Impact of blood testing on patient disposition from the emergency department

Objective: To determine whether blood test results lead to a change in planned disposition of patients from the ED. Methods: A prospective review of the anticipated and actual disposition of patients from the ED before and after blood test results, including stratification by seniority of medical staff. Results: There were 256 patients enrolled, 53% had blood tests requested. Expected disposition was not altered by test results in 87% of patients having blood tests. Medical staff were poor at identifying those patients whose disposition would be altered by their blood results (sensitivity 44%, specificity 72%, negative predictive value 89%). Seniority of medical staff was not associated with an alteration in disposition due to the blood results (P = 0.37). Conclusions: Blood test results have minimal impact on expected patient disposition from the ED. Recognition of this may improve resource utilisation with earlier discharge planning.     

疗养院放射科急诊工作体会

<正>疗养院放射科遇到急症的情况较少,但是一旦遇到,病人病情往往较重,需要放射科医生紧急正确处理后,临床医师才能及时正确地抢救病人。放射科遇到急症时必须注意几点:①要尽可能快地检查病人,以便给临床医师争取更多的抢救时间。②尽量减少搬动病人,以免增加病     

急诊老年肺部感染患者病原学分析

目的 探讨急诊60岁以上老年患者肺部感染的主要致病菌及细菌耐药性.方法 选取我科2005-01～2010-10期间>60岁以上肺部感染患者痰培养细菌1386株的药敏结果,药敏试验使用VITEK2-COMPACT全自动细菌检定仪,药敏结果的判断使用CLSI判断标准.结果 痰培养结果中位列前5位的菌株分别为鲍曼不动杆菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌,共占所有培养菌株的78.3%.痰培养药敏结果显示,鲍曼不动杆菌对大多数药敏实验药物耐药性增高,包括对碳青霉稀类药物的耐药率达到55%左右,较前几年的对碳青霉稀类药物耐药率增高.金黄色葡萄球菌未发现有万古霉素耐药的菌株.铜绿假单胞菌对多种药物耐药,但对阿米卡星仍有很高的敏感性.肺炎克雷伯杆菌和大肠埃希菌耐药性明显增加,肠杆菌科细菌对碳青霉烯类抗生素耐药与是否产ESBLs无任何相关性.结论 老年人肺部感染发生率高,应积极预防感染,加强病原学检测,合理选用抗生素,避免新的耐药菌出现.     

Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department

Background

Suicide screening scales have been advocated for use in the ED setting. However, it is currently unknown whether patients classified as low-risk on these scales can be safely discharged from the emergency department. This study evaluated the utility of three commonly-used suicide screening tools in the emergency department to predict ED disposition, with special interest in discharge among low-risk patients.

The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department

This prospective cohort study evaluated the effectiveness and safety of a selective discharge policy for patients treated with racemic epinephrine (RE) and intramuscular (IM) dexamethasone (DEX) in the emergency department (ED). Children younger than 13 years of age presenting to the ED with croup who were treated with RE and IM DEX and discharged home were enrolled in the study. Patients were discharged home if they were free of intercostal retractions and stridor at rest, following a 2 h observation period. Telephone follow up determined whether further medical attention for croup was required within 48 h of discharge from the ED. Eighty-two patients were enrolled in the study over a one year period. Six of these patients (7%) required follow up for croup within 48 h of discharge and 2 (2%) required admission. We conclude that a subset of patients with croup treated with RE and IM DEX in the ED can be safely discharged home.     

Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction

BackgroundThe objective of this study was to explore factors associated with the triage category assigned by the triage nurse for patients ultimately diagnosed with acute myocardial infarction.MethodsThis was a retrospective analysis of 12 months of data, on adult emergency department patients ultimately diagnosed with acute myocardial infarction. Data were obtained from hospital databases and included patient demographics, patient clinical characteristics and nurses’ experience.ResultsOf the 153 patients, 20% (95% CI: 14–27%) were given a lower urgency triage category than recommended by international guidelines. Compared to patients who were triaged Australasian Triage Category 1 or 2, patients with an Australasian Triage Category 3–5 were older (mean age 76 versus 68 years), more likely to be female (63% versus 32%), more likely to present without chest pain (93% versus 35%) and less likely to have a cardiac history (3.3% versus 17.9%). A slightly higher proportion of patients Australasian Triage Category 3–5 were triaged by an experienced nurse (50%) compared to patients categorised Australasian Triage Category 1–2 (35.2%) but this finding did not reach statistical significance.ConclusionsOne in five presentations was given a lower urgency triage category than recommended by international guidelines, potentially leading to delays in medical treatment. The absence of chest pain was the defining characteristic in this group of patients, along with other factors identified by previous research such as being of female sex and elderly.     

Characteristics,clinical care,and disposition barriers for mental health patients boarding in the emergency department

Background and objectivesLack of mental health resources, such as inpatient psychiatric beds, has increased frequency and duration of boarding for mental health patients presenting to U.S. emergency departments (EDs). The purpose of this study is to describe characteristics of mental health patients with an ED length of stay of one week or longer and to identify barriers to their disposition.MethodsThis study was conducted in an academic ED in which emergency psychiatric evaluations and care are provided by a Psychiatric Emergency Services (PES) team contained within the Department of Emergency Medicine. Prolonged boarding was defined as an ED length of stay of 7 days or more. Pediatric, adult, and geriatric mental health patients with prolonged ED boarding from January 1 to August 31, 2019 were included. This study includes prospective data collection of the boarding group and retrospective identification and data collection of a comparison group of non-barding patients over the same 8-month period to compare patient characteristics and outcomes for each group.ResultsBetween January 1 and August 31, 2019, the PES team completed 2,745 new assessments of mental health patients, of whom 39 met criteria for prolonged ED boarding. The following characteristics were associated with boarding: child (8%), male (64%), having Medicaid (49%) or both Medicaid and Medicare (18%), and having either a neurodevelopmental (15%) or neurocognitive disorder (15%) with a median stay of 18 days. Barriers to discharge included being declined from all state inpatient psychiatric hospitals (69%), declined from community living environments (21%), or declined from both (10%). The most common ED non-boarding patients were: Caucasian (64%), have a diagnosis of unspecified mental disorder (including suicidal ideation) or other specified mental disorder (59%) and have private insurance (42%) with a median stay of 1 day.ConclusionIn this study of mental health patients with prolonged ED stays, the primary barrier to disposition was the lack of patient acceptance to inpatient psychiatric hospitals, community settings, or other housing. Early identification of potential prolonged boarding, quality treatment and care for those patients, and effective case management, may resolve the ongoing challenges of boarding within the ED.