scholarly journals Initial assessment in emergency departments by chief complaint and respiratory rate

2021 ◽  
Author(s):  
Shoko Soeno ◽  
Konan Hara ◽  
Ryo Fujimori ◽  
Katsuhiko Hashimoto ◽  
Toru Shirakawa ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Emergency Departments ◽  
Chief Complaint ◽  
Initial Assessment

scholarly journals Investigating the relationship between how a chief complaint is expressed and the patient workflow

2020 ◽  
Vol 6 (2) ◽  
pp. 63-67
Author(s):  
Sajjad Ahmadi ◽  
Niloufar Pouresmaeil ◽  
Farima Najjarian ◽  
Samad Shams Vahdati ◽  
Maryam Rahimpour Asenjan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Departments ◽  
Descriptive Analysis ◽  
Critical Role ◽  
Kidney Injury ◽  
Chief Complaint ◽  
Final Decision ◽  
Bloody Stool ◽  
The Relationship

Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc) were used for descriptive analysis and linear regression was used to analyze the correlation among findings. Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints. Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

scholarly journals Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240206
Author(s):  
Steve Goodacre ◽  
Ben Thomas ◽  
Ellen Lee ◽  
Laura Sutton ◽  
Amanda Loban ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Departments ◽  
Performance Status ◽  
Observational Cohort Study ◽  
Initial Assessment ◽  
Organ Support ◽  
Impaired Performance ◽  
Observational Cohort ◽  
Hospital Emergency Departments ◽  
Record Review

Background Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results. Methods and findings We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with suspected and confirmed COVID-19 had similar age, performance status and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.1% v 15.5%). Conclusions Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support. Registration ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533.

Validating a Chief Compliant List for Low Resource Settings: A Methodologic Case Study

2020 ◽  
Author(s):  
Bhakti Hansoti ◽  
Elizabeth Hahn ◽  
Aditi Rao ◽  
Jordan Harris ◽  
Alexander Jenson ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Care Delivery ◽  
Human Immunodeficiency Virus Testing ◽  
Chief Complaint ◽  
System Level ◽  
World Health ◽  
Coding System ◽  
Low Resource ◽  
Chief Complaints ◽  
Symptom List

Abstract Background:The chief or presenting complaint is the reason for seeking health care, often in the patient’s own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Collaboration with World Health Organization colleagues resulted in the creation of a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. A validated universal chief complaint list would profoundly benefit clinicians, researchers, and policymakers world-wide by allowing the communication and development of system-level priorities based around the signs and symptoms most often experienced by the patients being served.Methods: This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3,357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list.Results:Overall, 3,537 patients’ chief complaints were reviewed, of which 640 were identified as ‘potential mis-matches’. When considering the 191 confirmed mis-matches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. “Pain” was used 2,076 times for 58.7% of all patients. Testing for validity and functionality of the initial draft dataset via user feedback and expert-panel modified Delphi analysis resulted in several substantial changes to the pilot symptom list.Conclusions:This study found that the pilot symptom list with aforementioned modifications could be applied to a low resource emergency system. Recommendations for additions, modifications, and/or deletions from the draft chief complaint list will improve validity and functionality of the list in low resource environments. Selecting a patient’s chief complaint from a validated list offers a vital tool to help triage patients, streamline emergency care delivery, and improve patient outcomes.

School Nurses on the Front Lines of Medicine

2016 ◽  
Vol 32 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Children And Adolescents ◽  
Head Trauma ◽  
School Nurse ◽  
School Nurses ◽  
Chief Complaint ◽  
Initial Assessment ◽  
Local Emergency Department

Head trauma is a common chief complaint encountered by school nurses. This article describes the initial assessment and management of head trauma in children and adolescents, delineates reasons that may prompt the school nurse to transfer a student to a local emergency department, and discusses the role of the school nurse when a student is diagnosed with a concussion.

scholarly journals Calibrating a chief complaint list for low resource settings: a methodologic case study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
B. Hansoti ◽  
E. Hahn ◽  
A. Rao ◽  
J. Harris ◽  
A. Jenson ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Human Immunodeficiency Virus Testing ◽  
Chief Complaint ◽  
Ease Of Use ◽  
Local Context ◽  
Coding System ◽  
Low Resource ◽  
Epidemiologic Surveillance ◽  
Chief Complaints ◽  
Symptom List

Abstract Background The chief or presenting complaint is the reason for seeking health care, often in the patient’s own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs. Methods This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list. Results Overall, 3537 patients’ chief complaints were reviewed, of which 640 were identified as ‘potential mismatches.’ When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. “Pain” was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list. Conclusions This study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.

Rates of Presentation, Treatments and Serious Neurologic Disorders Among Children and Young Adults Presenting to US Emergency Departments With Headache

2020 ◽  
pp. 088307382097913
Author(s):  
Sriram Ramgopal ◽  
Amy Z. Zhou ◽  
Robert W. Hickey ◽  
Jennifer R. Marin
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Emergency Departments ◽  
Cross Sectional Study ◽  
Chief Complaint ◽  
Sample Survey ◽  
Cross Sectional ◽  
Neurologic Disorders ◽  
Children And Young Adults ◽  
Nationally Representative

Objective: To evaluate rates of presentation, neuroimaging, therapies, and serious neurologic disorders (SNDs) among children and young adults presenting to the emergency department with headache. Methods: We performed a cross-sectional study of a nationally representative sample survey of visits to US emergency departments between 2002 and 2017. We identified encounters of patients ≤25 years old with chief complaint of headache. We report the rates of presentation, imaging, and treatments and report proportions having concomitant diagnoses of serious neurologic disorders. Results: Among encounters ≤25 years, 2.0% had a chief complaint of headache, with no change in the yearly rates of encounters ( P = .98). Overall, 20.8% had a head computed tomography (CT), with a reduction in performance between 2007 and 2016 ( P < .01). One-quarter (25.2%, 95% confidence interval [CI] 22.2%-28.3%) were given narcotics and 2.5% (95% CI 1.7%-3.2%) had serious neurologic disorders. Conclusion: Overall, 2.0% of emergency department encounters among patients ≤25 years were for headache, with low rates of serious neurologic disorders. CT use appeared to be declining.

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