Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND:

A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.

METHODS:

A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010.

RESULTS:

The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1–30.5); Arabic, 10.3 (95%CI: 7.3–13.2); Spanish, 9.4 (95%CI: 7.1–11.7); Chinese, 8.6 (95%CI: 2.6–14.6); Hindi, 4.0 (95%CI: 2.2–5.7); Italian, 3.5 (95%CI: 1.6–5.4); and German, 2.7 (95%CI: 1.0–4.4). The final regression model explained 17% of the variability in LOS.

CONCLUSION:

There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland’s public hospitals.KEY WORDS: Emergency department, Language, Length of stay     

Does rapid blood sampling affect the retention time of patients with low-acuity complaints in the emergency department?

IntroductionThe objective of this study was to investigate whether rapid blood sampling during triage led to shorter stays in the emergency department for patients with low-acuity complaints.MethodsA retrospective study was conducted in the emergency department (ED) of a tertiary university hospital in South Korea. A pre- and post-intervention comparison analysis was completed over one-month periods in June and September 2014. Data included triage level of the patient, time from the ED visit to receiving the doctor’s orders, result time of complete blood cell count (CBC) and blood chemistry (BC), length of stay (LOS) for all discharged patients who required blood sampling.ResultsA total of 1308 patients were reviewed for June 2014, and 1530 patients were reviewed for September 2014. The time from the order to the CBC and BC result report differed significantly between the two groups (p < 0.001). Rapid blood sampling did not affect the LOS in the ED (p = 0.339).ConclusionRapid blood sampling performed immediately after triage was not effective for shortening the LOS of discharged patients with low acuity complaints who required blood sampling. But the LOS of ED patients who were referred to the internal medicine was reduced by more than 200 min.     

碘对比剂外渗影响因素的系统评价

目的 系统评价放射科使用碘对比剂检查患者发生外渗的相关影响因素。方法 检索Web of Science、PubMed、Embase、Cochrane Library、CNKI、中国生物医学文献数据库、万方数据库和维普数据库从建库至2020年10月发表的碘对比剂外渗相关研究,在文献质量评价的基础上,采用定性分析方法描述纳入文献的信息和结果,并依据不同影响因素进行相关结果的提取和分类归纳。结果 纳入19项研究,共报告2 063例碘对比剂外渗,文献质量等级均为中、高级,提取外渗发生的影响因素,包括年龄较大、女性、使用高压自动注射器、高注射速率、导管留置部位、留置时间过长、使用未加热的高黏度对比剂等。结论 碘对比剂外渗与多种因素相关,建议临床工作者提高对这些因素的关注,早期识别外渗高危患者,预防碘对比剂外渗。     

含碘对比剂静脉外渗护理管理实践指南

目的 制定《含碘对比剂静脉外渗护理管理实践指南》,为降低CT检查时含碘对比剂静脉外渗发生率和规范含碘对比剂静脉外渗的管理提供参考依据。 方法 严格按照循证护理实践指南制定的方法,构建《含碘对比剂静脉外渗护理管理实践指南》草案,采用临床指南研究与评估系统目录Ⅱ对指南草案进行专家评审,根据专家评审结果和建议对指南进行修改,形成正式指南。 结果 构建的指南推荐意见涵盖含碘对比剂静脉外渗的风险因素、预防方法、处理原则、质量改进4个方面的内容。 结论 《含碘对比剂静脉外渗护理管理实践指南》是根据最佳证据、临床实际情况以及专业人员判断形成的循证指南,可为放射科及临床医护人员进行科学决策提供实践依据。     

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and mu...     

Nursing role model for computed tomography contrast injection decreases extravasation rates

Extravasation of intravenous contrast administered for computed tomography remains of concern in pediatric patients. It is of great interest to any pediatric radiology department to decrease extravasation events in an effort to reduce even small adverse outcomes and improve the overall patient experience in the radiology department. Here, a total of 17 extravasation events, as reported and documented in departmental quality assurance at our institution over 4 years, were retrospectively reviewed for factors contributing to the number of adverse extravasation events. We found that pediatric nursing plays a central role in both achieving and maintaining a low extravasation rate at our institution.     

综合医院康复科住院患者分析

目的探讨综合医院康复科住院患者的疾病种类、患者来源、住院日和住院费用的特点。方法利用“广东省病案查询统计系统”回顾查询2004至2005年在康复科出院的全部病例1246例,统计分析患者的年龄、疾病诊断数、患者来源、平均住院日和住院费用。结果2005年出院患者平均年龄(61．2±13．7)岁；第一诊断脑梗死占40．4%,脑出血12．6%,颈椎病5．7%,脑外伤5．1%,骨折3．7%；患者平均患病病种(5．52±1．54)个；患者首次入院科室以康复科最多,占47．7%,转科患者占52．3%,其中神经内科26．4%,神经外科7．9%,骨科4．1%；人均住院时间为39．1 d,康复科入院患者23．7 d,神经内科入院患者44．4 d,骨科患者60．2 d,神经外科患者62．4 d；脑梗死患者人均住院时间为34．2 d,骨折63．5 d,颈椎病21．3 d,颅脑外伤64．2 d；人均住院总费用36 167．7元,其中药品费最高,占47．6%,其次是治疗费。颈椎病的费用最低,颅脑外伤最高。结论康复科住院患者病种多,人均患病数多,转科患者多,住院时间长,住院费用高,药品费比例过高。应该在患者转科前开展康复治疗,减少用药,才能缩短住院日,降低费用,减轻患者的负担。     

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).

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.     

The impact of the improvement in internal medicine consultation process on ED length of stay

Introduction

Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy.

Invasive ventilation in the emergency department: Part 2: Implications for patient safety

The use of mechanical ventilation in the Emergency Department requires adequate resources in order to maintain patient safety and avoid potential risks. Moreover, developments in technology require increased knowledge of mechanical ventilation techniques to address the complexity of decision-making involved. Organisational issues and system factors have the potential to negatively impact on the ability of the emergency service to provide optimum care to patients receiving mechanical ventilation. These issues include staffing and skill-mix, demand on emergency services, role-delineation, scope of practice, and current mechanisms for monitoring of quality and safety. Furthermore, in response to advances in ventilator technology, current education programs for both nursing and medical staff require review to ensure that they provide comprehensive information about the types of ventilation techniques now available and the relative risks and benefits associated with their application.This article is the second in a two-part series and explores the educational and organisational factors that impact upon safety and quality of care delivered to patients receiving mechanical ventilation in the emergency department. Recommendations for future policy development, curriculum review and reporting mechanisms to support further research in the application of mechanical ventilation in the emergency department are made.     

急诊滞留时间的研究进展

阐述急诊滞留时间的概念,综述急诊滞留时间的研究进展。指出目前国内外关于急诊滞留时间的评估、具体原因及有效的缓解措施还没有系统研究,今后仍需要更多的多中心调查研究。     

Paramedic determination of appropriate emergency department destination

Background

Freestanding emergency departments (FSED) are equipped to care for most emergencies, but do not have all the resources that hospital-based emergency departments (ED) offer. As the number of FSEDs grows rapidly, emergency medical services (EMS) must routinely determine whether a FSED is an appropriate destination. Inappropriate triage may delay definitive care, potentially increasing morbidity, mortality, and resource utilization. We sought to evaluate paramedics' ability in determining whether a FSED is the most appropriate destination.

运用正交试验法研究肝脏动态CT增强扫描最佳参数

目的 研究肝脏动态CT增强扫描的最佳参数。方法 选择3因素2水平正交试验表(L_82~7),安排40例病人造影检查,分析不同造影剂注射速度(2ml/秒、4ml/秒)、注射时相(单、双相)及延迟时间(15秒、30秒)对造影观察指标的影响。结果 造影剂注射速度为4ml/秒及延迟30秒扫描可获得较高的肝脏增强峰值(p<0.05);采用2ml/秒的注射速度及双相注射可获得较长的到达肝脏增强峰值的时间;采用2ml/秒的注射速度可获得较长的平衡期及最佳扫描间隙。结论 2ml秒注射速度、双相注射及延迟30秒扫描可作为肝脏动态CT增强扫描的最佳参数组合。     

急诊科开展神经内窥镜手术的初步报告

目的 :探讨神经内窥镜在急诊科的应用价值。方法 :1999年 7月至 2 0 0 0年 3月我院急诊科开展神经内窥镜手术治疗各类颅内血肿 2 3例 2 4次 ,其中脑内血肿清除术 2 0例 ,慢性硬膜下血肿 /积液引流术 3例。结果 :根据ADL评分标准 ,脑血肿组治疗效果为基本痊愈(ADL1级 ) 2例 ,显著进步 (ADL改善≥ 2级 ) 6例 ,进步 (ADL改善 1级 ) 6例 ,无改变 1例 ,死亡 5例 ;超早期治疗的 3例效果最好。 3例硬膜下血肿 /积液均治愈。本组并发术后出血 2例 ,切口脑脊液漏 1例 ,无其它手术直接相关的并发症。结论 :神经内窥镜手术创伤小 ,直视下操作 ,并发症少 ,病人康复快 ,为脑出血、慢性分隔型硬膜下血肿的治疗提供了一种新的有效方法 ,值得在急诊科开展。     

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.