Uniting emergency and inpatient clinicians across the ED–inpatient interface: The last frontier?

Unwell patients in the ED requiring inpatient admission must negotiate the interface between the ED and inpatient wards. Despite its importance and scale, this ED–inpatient interface (EDii) is poorly characterised. The aim of this paper is to clearly define the EDii and to describe its importance to (i) the patient: delays to admission and errors in communication across the EDii can increase adverse outcomes; (ii) the hospital: poor EDii function reduces hospital efficiency and effectiveness; and (iii) the healthcare system: half of all hospital inpatient admissions occur via the EDii and so EDii affects system‐wide performance. The EDii can be defined as the dynamic, transitional phase of patient care in which responsibility for, and delivery of care, is shared between ED and inpatient hospital services. The EDii is characterised by a complex interplay of patient, hospital and system factors. A clear definition of the EDii and an understanding of its importance will assist future research and interventions to improve patient outcomes.     

比伐卢定与替罗非班联合肝素在急诊PCI治疗中的疗效与安全性比较

目的观察和对比比伐卢定与替罗非班联合肝素在急诊经皮冠状动脉介入(PCI)治疗中的疗效与安全性。方法选取90例行急诊PCI治疗的急性ST段抬高型心肌梗死(STEMI)患者作为研究对象,将其随机分为观察组和对照组,每组45例。观察组患者于术前静脉给予比伐卢定进行辅助治疗,对照组患者于术前静脉给予替罗非班联合肝素进行辅助治疗。对2组患者术后心电图ST段回降幅度、心肌梗死溶栓治疗临床试验(TIMI)血流分级及出血并发症的发生情况进行观察和比较。结果 2组患者急诊PCI术后ST段回降百分比分布和梗死血管血流TIMI分级的差异均无统计学意义(χ2=0.212、0.690,P0.05),但观察组患者急诊PCI术后活动性出血的发生率及咯血的发生率均显著低于对照组(χ2=7.283、3.873,P0.05)。结论在STEMI患者的急诊PCI治疗中,应用比伐卢定的术后出血并发症的发生率较低,安全性较高。     

细节护理在急诊休克患者护理中的应用研究

目的探讨细节护理在急诊休克患者护理中的应用。方法选择126例创伤性休克患者,按照住院顺序分为实验组与对照组各63例。对照组仅给予常规的急救护理干预措施,实验组则在对照组基础上给予细节护理干预措施,比较2组患者抢救成功率、有效救治时间、并发症情况、医疗差错、医疗纠纷情况、预后情况以及护理满意度。结果实验组抢救成功率高于对照组,有效抢救时间多于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。实验组医疗差错、医疗纠纷发生率均低于对照组,差异有统计学意义(P0.05)。实验组恢复良好者显著多于对照组,而致残率及病死率显著低于对照组,差异均有统计学意义(P0.05)。实验组护理满意率为96.83%,显著高于对照组的87.30%(P0.05)。结论对急诊休克患者实施细节护理,不仅可降低并发症发生率、医疗纠纷发生率,减少医疗差错、致残及死亡患者,还能提高抢救成功率,增加有效抢救时间,改善护理满意度及预后。     

院前急救护理路径在脑卒中患者中的应用效果

目的探讨院前急救护理路径在脑卒中患者院前急救中的应用效果。方法收集本院2014年5—12月入院的40例脑卒中患者作为对照组,2015年1—9月入院的40例作为实验组。对照组患者给予常规护理,实验组患者加施院前急救护理路径干预,比较2组患者相关临床指标、不良事件、医生与护士长满意度与幸存患者满意度。结果实验组患者呼救至院前急救间隔、呼救至入院治疗间隔、住院时间与医疗费用显著低于对照组(P0.05);实验组患者致残率与投诉发生率显著低于对照组(P0.05);实验组患者实施后医生与护士长满意评分组间比较显著高于对照组(P0.05);实验组患者护理满意度显著优于对照组(P0.05)。结论院前急救护理路径在脑卒中患者院前急救中的应用效果显著,可提高满意度。     

616例急诊患者自身抗体检测结果回顾性分析

目的了解急诊患者血清中抗核抗体(ANA)的检出率,探讨自身抗体在急诊患者中的诊断价值。方法回顾性分析2013年5月至2015年7月本院急诊患者自身抗体检出率与首诊症状的相关关系。结果 616例急诊患者ANA阳性率为10.9%(67/616),其中诊断为系统性红斑狼疮的ANA阳性率为100%(3/3),出现肢体疼痛、浮肿和肌无力,发热咳嗽,胸闷和呼吸困难等症状患者的ANA阳性率较高,分别是36.7%(11/30)、13.0%(15/115)、22.9%(8/35)。在67例ANA阳性患者中,滴度大于等于1∶320的患者占68.7%(46/67)。抗核抗体谱阳性患者114例,占18.5%(114/616),其中以抗Ro-52、抗SS-A、抗HI、抗M2抗体的阳性率较高,分别为8.1%(50/616)、6.8%(42/616)、3.1%(19/616)和2.8%(17/616)。结论对急诊就诊者出现关节疼痛、浮肿,发热、呼吸困难等症状的患者应提高警惕,注意多种自身抗体的联合检测,提高自身免疫性疾病的诊断率,以防漏诊。     

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening,Brief Intervention,and Referral to Treatment (SBIRT) for Emergency Medicine Residents

Problem: Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. Intervention: We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. Context: We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). Outcome: Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. Lessons Learned: Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.