scholarly journals Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center

2021 ◽  
Author(s):  
M. Frink ◽  
V. Ketter ◽  
N. Klama ◽  
T. Knauf ◽  
S. Betz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Surgical Treatment ◽  
Control Period ◽  
Control Group ◽  
Trauma Patients ◽  
Care Hospital ◽  
Orthopedic Trauma ◽  
Time Period ◽  
Number Of Patients ◽  
Level 1

Abstract Introduction While overcrowding of emergency departments was often reported in the recent years, during the early phase of the pandemic, a reduction in patient numbers was seen. The aim of the current study was to describe the orthopedic trauma patient cohort presenting to the emergency department (ED) during the early pandemic period as compared to the cohort from the analogue time period 2019. Materials and methods A single-center case–control study was performed. All the consecutive orthopedic trauma patients > 12 years presenting to the ED were included. Patients in the same time period in 2019 served as the control group. Results Compared to 2019, in 2020, 33% less patients presented in the emergency department. Patients treated in 2020 were significantly older, significantly more often brought to ED by emergency medical services and significantly more often admitted. The number of fractures and diagnoses requiring surgical treatment decreased only slightly and the proportion of these patients among all the patients was significantly higher during the pandemic than in the control period. Furthermore, a higher percentage of polytrauma patients could be found in 2020 as well. Analysis of Manchester Triage System showed significantly less not urgent patients in 2020. Conclusion The present study shows a significant decline in the number of patients treated in the ED during the pandemic period but at the same time almost identical numbers of patients with fractures or diagnoses requiring surgical treatment. In the context of an overall decline in patient numbers, a stronger concentration on level 1 trauma centers seems to be evident during the pandemic.

scholarly journals Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a non-equivalent control group design

2021 ◽  
Author(s):  
Nina Weldingh ◽  
Marte Mellingsæter ◽  
Bendik Hegna ◽  
Jūratė Šaltytė Benth ◽  
Gunnar Einvik ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Control Group ◽  
Care Hospital ◽  
Control Group Design ◽  
Group Design ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
Equivalent Control

Abstract Background Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the prevalence of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. Methods This study had a non-equivalent control group design and a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the Four Assessment Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from patient journals. Results Implementation of the dementia-friendly hospital program did not show any significant effect on the identification of patients with CI. However, the proportion of the patients with CI who received preventive measures increased by 32.2% (P < .001), compared to the control group. The share of patients screened with 4AT within 24 hours increased from 0–35.5% (P < .001). Furthermore, the number of patients with CI who were prescribed antipsychotic/hypnotic medications was reduced by 24.5% (P < .001). There were no differences in delirium, 30-day readmission or 30-day mortality. Conclusions Implementation of a model for early screening and multifactorial nonpharmacological interventions for patients with CI and delirium using quality improvement methodology may improve management of this patient group, increase staff awareness of family involvement, and reduce prescriptions of antipsychotics, hypnotics and sedatives. Trial registration: The protocol of this study was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System with the registration number: NCT04737733 and date of registration: 03/02/2021.

Treatment Methods for Different Variations Syndrome Mirizzi

2021 ◽  
Vol 04 (04) ◽  
Author(s):  
Omarov N.B., Aimagambetov M. Zh. ◽  
◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Main Group ◽  
Mirizzi Syndrome ◽  
Long Term Results ◽  
Control Group ◽  
Type Iii ◽  
Type Iv ◽  
Number Of Patients

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

scholarly journals Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 308 ◽  
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Sabino Luzzi ◽  
Cristian Gragnaniello ◽  
Alice Giotta Lucifero ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Mortality Rates ◽  
Control Group ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

scholarly journals COVID-19 lock-down significantly reduced the number of surgical presentations in an emergency department

2020 ◽  
Author(s):  
René Fahrner ◽  
Stefan Bähler ◽  
Gregor Lindner
Keyword(s):  
Emergency Department ◽  
Time Course ◽  
Control Period ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Medical Specialty ◽  
World Health ◽  
Number Of Patients ◽  
Health Organization ◽  
The Impact

Abstract IntroductionCoronavirus disease 2019 (COVID-19) is an acute virus infection that was declared by the World Health Organization (WHO) as a pandemic. As a consequence, the Swiss government decreed a public lock-down to reduce and restrict further infections. The aim of this investigation was to provide the impact of the COVID-19 lock-down on the presentations of patients in an interdisciplinary emergency department (ED).Patients, Materials and MethodsA retrospective study was performed at an interdisciplinary Swiss ED during the lock-down period. All patients who presented to the ED were enrolled in this investigation and compared to a control cohort during the same time period in 2019. Data regarding patient characteristics, medical specialty, time course of presentations during the observation period, and outpatient or hospital admission were analyzed.ResultsIn total, 7,072 patients were included in the final analysis. During the lock-down period, the number of ED presentations significantly decreased by 29% in comparison to the control period in the previous year (p<0.0001). The analysis of the time course revealed that in each week, the number of patients was lower, with a 13% to 43% reduction. Irrespective of the medical specialty, the number of presentations decreased during the COVID-19 situation, whereas this decrease was higher in surgical diseases (31%, p<0.0001) than in non-surgical presentations (3.6%, p=0.4).DiscussionThe socio-economic lock-down impacted the number of presentations in an ED. Mainly, surgical diseases and injuries were affected in terms of a reduction of presentations during the COVID-19 lock-down period.

scholarly journals Incidence and surgical care of retinal detachment during the first SARS-CoV-2 lockdown period at a tertiary referral center in Austria

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248010
Author(s):  
Markus Schranz ◽  
Michael Georgopoulos ◽  
Stefan Sacu ◽  
Adrian Reumueller ◽  
Gregor S. Reiter ◽  
...  
Keyword(s):  
Reference Group ◽  
Case Series ◽  
Surgical Care ◽  
Control Group ◽  
Tertiary Referral ◽  
Total Delay ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Time Period ◽  
Number Of Patients

Purpose To assess the influence of the SARS-CoV-2 lockdown in spring on frequency, severity and quality of care of rhegmatogeneous retinal detachments (RRD) in a tertiary referral center in Vienna, Austria. Methods Single center, consecutive case series with historical controls. Patients presenting with primary RRD during the first Austrian SARS-CoV-2 lockdown (March 16th–May 3rd 2020) and a corresponding control group consisting of the same time period of the preceding 3 years. Results The mean number of patients with RD in the reference group (RG) was 22 (± 1) and in the lockdown group (LG) 15. Median total delay, defined as onset of symptoms until surgery, in the RG was 5 (lower quartile: 3.0; upper quartile: 8.0) compared to 7 (3.0; 12.0) days in the LG, (p = 0.740). During the lockdown 67% of patients were referred from an external ophthalmologist compared to 52% in the RG, (p = 0.395). 34% of patients in the RG presented with an attached macula compared to 33% in the LG (p = 0.597). PVR was present in 49% of cases in the RG compared to 73% in the LG. Single surgery success (SSS) rates were lower in the LG (73.3%) compared to the RG (85.3%), (p = 0.275). Conclusion Patients with RRD during the SARS-CoV-2 lockdown presented and were treated within acceptable time limits, showed the same macula-on ratios but a higher PVR rate and a tendency towards worse SSS rates compared to the time period of the preceding 3 years.

scholarly journals LABORATORY TURN AROUND TIME FOR BIOCHEMISTRY INVESTIGATIONS IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL OF NORTH INDIA

2021 ◽  
Vol 9 (01) ◽  
pp. 669-679
Author(s):  
Zaffar N. ◽  
◽  
Rashid H. ◽  
Hussain S. ◽  
Hakeem A ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Turnaround Time ◽  
North India ◽  
Care Hospital ◽  
Time Period ◽  
Accident And Emergency ◽  
Analytical Phase ◽  
Analytical Time

Background: Laboratory turnaround time is considered one of the most important indicators of work efficiency in hospitals, physicians always need timely results to take effective clinical decisions especially in the emergency department where these results can guide physicians whether to admit patients to the hospital, discharge them home or do further investigations. Objectives:1. Calculate the turnaround time for the various biochemical investigations from accident and emergency of a tertiary care institute.2. To find the percentage contribution of pre-analytical, analytical and post analytical phases to TAT. Materials And Methods: This was a prospective, descriptive, single-center study of therapeutic TAT for biochemistry investigations in accident and emergency of a tertiary care hospital. The study was conducted for a period of 3 months from August 2020 to Oct 2020. During the present study period, all biochemistry investigations ordered from emergency department were studied. The Lundberg definition of TAT was used in this study. This means that the pre-analytical TAT used was from the point of order of tests to the receipt of samples at the laboratory. Similarly, the post-analytic phase started from the time results were available at the laboratory to the point where clinicians could access it for action. Results: The turnaround time (TAT) has been monitored in total of 7515 samples for biochemistry evaluation with mean TAT of 169.6 min. It was noted that the mean pre analytical time period was 120.6 min , Analytical time period 34 min while post analytical time period was 15 min. In our study of the pre-analytical phase 37.7%, 39.3%, and 22.9% tests were completed within 60, 60-120 and above 120 minutes, respectively. With respect to the analytical phase, 80.4% and 19.6% tests were completed below 45 minutes and above 45 minutes, respectively. Conclusion: Despite efficient analysis of results, the pre analytic period contributed the most delay in TAT. Collecting the blood samples under standard conditions, filling the test request slips, marking the samples with bar-codes contributed to long TAT.

scholarly journals LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S11-S12
Author(s):  
I. Stiell ◽  
M. Taljaard ◽  
A. Forster ◽  
L. Mielniczuk ◽  
G. Wells ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Control Period ◽  
Care Hospital ◽  
Index Visit ◽  
Rapid Access

Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.

scholarly journals Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

2007 ◽  
Vol 89 (5) ◽  
pp. 513-516 ◽  
Author(s):  
JTK Melton ◽  
S Jain ◽  
B Kendrick ◽  
SD Deo
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Ambulance Service ◽  
Case Mix ◽  
Trauma Patients ◽  
Patient Case ◽  
Average Hospital ◽  
Acute Setting ◽  
Time Period ◽  
Emergency Ambulance

INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed.

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