Left Without Being Seen in a Tertiary Care Hospital Emergency Department in Lebanon

Background: Increasing Emergency Department (ED) stretcher occupancy with admitted patients at our tertiary care hospital has contributed to long Physician Initial Assessment (PIA) times. As of Oct 2019, median PIA was 2.3 hours and 90th percentile PIA was 5.3 hours, with a consequent 71/74 PIA ranking compared to all Ontario EDs. Ambulatory zone (AZ) models are more commonly used in community EDs compared to tertiary level EDs. An interdisciplinary team trialled an AZ model for five days in our ED to improve PIA times. Aim Statement: We sought to decrease the median PIA for patients in our ED during the AZ trial period as compared to days with similar occupancy and volume. Measures & Design: The AZ was reserved for patients who could walk from a chair to stretcher. In this zone, ED rooms with stretchers were for patient assessment only; when waiting for results or receiving treatment, patients were moved into chairs. We removed nursing assignment ratios to increase patient flow. Our outcome measure was the median PIA for all patients in our ED. Our balancing measure was the 90th percentile PIA, which could increase if we negatively impacted patients who require stretchers. The median and 90th percentile PIA during the AZ trial were compared to similar occupancy and volume days without the AZ. Additional measures included ED Length of Stay (LOS) for non-admitted patients, and patients who leave without being seen (LWBS). Clinicians and patients provided qualitative feedback through surveys. Evaluation/Results: The median PIA during the AZ trial was 1.5 hours, compared to 2.1 hours during control days. Our balancing measure, the 90th percentile PIA was 3.7 hours, compared to 5.0 during control days. A run chart revealed both median and 90th percentile PIA during the trial were at their lowest points over the past 18 months. The number of LWBS patients decreased during the trial; EDLOS did not change. The majority of patients, nurses, and physicians felt the trial could be implemented permanently. Discussion/Impact: Although our highly specialized tertiary care hospital faces unique challenges and high occupancy pressures, a community-hospital style AZ model was successful in improving PIA. Shorter PIA times can improve other quality metrics, such as timeliness of analgesia and antibiotics. We are working to optimize the model based on feedback before we cycle another trial. Our findings suggest that other tertiary care EDs should consider similar AZ models.

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SARS-CoV-2 Antigen Detection to Expand Testing Capacity for COVID-19: Results from a Hospital Emergency Department Testing Site

Diagnostics ◽

10.3390/diagnostics11071211 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1211

Author(s):

Giulia Menchinelli ◽

Giulia De Angelis ◽

Margherita Cacaci ◽

Flora Marzia Liotti ◽

Marcello Candelli ◽

...

Keyword(s):

Emergency Department ◽

Predictive Value ◽

Tertiary Care ◽

Antigen Detection ◽

Care Hospital ◽

Hospital Emergency Department ◽

Rt Pcr ◽

Hospital Emergency ◽

Asymptomatic Patients ◽

Antigen Testing

Background: SARS-CoV-2 antigen detection has currently expanded the testing capacity for COVID-19, which yet relies on the SARS-CoV-2 RNA RT-PCR amplification. Objectives: To report on a COVID-19 testing algorithm from a tertiary care hospital emergency department (ED) that combines both antigen (performed on the ED) and RT-PCR (performed outside the ED) testing. Methods: Between December 2020 and January 2021, in a priori designated, spatially separated COVID-19 or non-COVID-19 ED areas, respectively, symptomatic or asymptomatic patients received SARS-CoV-2 antigen testing on nasopharyngeal swab samples. Antigen results were promptly accessible to guide subsequent, outside performed confirmatory (RT-PCR) testing. Results: Overall, 1083 (100%) of 1083 samples in the COVID-19 area and 1815 (49.4%) of 3670 samples in the non-COVID-19 area had antigen results that required confirmation by RT-PCR. Antigen positivity rates were 12.4% (134/1083) and 3.7% (66/1815), respectively. Compared to RT-PCR testing results, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antigen testing were, respectively, 68.0%, 98.3%, 88.8%, and 94.1% in the COVID-19 area, and 41.9%, 97.3%, 27.3%, and 98.6% in non-COVID-19 area. Practically, RT-PCR tests were avoided in 50.6% (1855/3670) of non-COVID-19 area samples (all antigen negative) from patients who, otherwise, would have needed antigen result confirmation. Conclusions: Our algorithm had value to preserve RT-PCR from avoidable usage and, importantly, to save time, which translated into a timely RT-PCR result availability in the COVID-19 area.

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VALIDATION OF QUICK COVID SEVERITY INDEX IN COVID PATIENTS ADMITTED THROUGH EMERGENCY DEPARTMENT OF A PRIVATE TERTIARY CARE HOSPITAL IN WEST BENGAL, INDIA

10.36106/ijsr/7821858 ◽

2021 ◽

pp. 53-55

Author(s):

Harsimran Singh Das

Keyword(s):

Emergency Department ◽

Respiratory Failure ◽

Tertiary Care Hospital ◽

Clinical Status ◽

Tertiary Care ◽

Severity Index ◽

Adult Patients ◽

Care Hospital ◽

Oxygen Requirement ◽

Clinical Tool

Introduction:qCSI (Quick COVID severity index) is a clinical tool established recently post pandemic to predict respiratory failure within 24 hours of admission in COVID-19 patients; respiratory failure being explain as increased oxygen requirement greater than 6L/min by low ow device, high ow device, noninvasive or invasive ventilation to maintain spO2 of greater than or equal to 94%, or death. Aim:To verify and validate the application of the qCSI in Emergency Department in Indian demographic for evidence-based guidance to aid physician decision making in safely dispositioning adult patients with COVID-19 with oxygen requirement less than or equal to 6L/min via low ow devices including nasal cannula and oxygen mask Materials and methods:This is an observational, retrospective study from Emergency Department in a private tertiary care hospital of admitted adult patients with COVID-19 disease. Clinical parameters in qCSI and disposition of 210 patients admitted through Emergency Department included in this study selected randomly was sought on admission and clinical status with level of care 24 hours following admission was recorded and compared with prediction based on qCSI from a period of 1 May 2020 to 31 October 2020. Result:We found that19(9.0%) patients Initial qCSI Score was Low, 80(38.1%) patients Initial qCSI Score was Low-intermediate, 84(40.0%) patients Initial qCSI Score was High-intermediate and 27(12.9%)patients Initial qCSI Score was High.qCSI Score after 24 hours 16(11.4%) patients were Low, 43(30.7%) patients were Low-intermediate, 63(45.0%) patients was High-intermediate and 18(12.9%) patients was High.Out of 210(100.0%) patients, 70 (33.3%) patients were critically ill. Conclusion:In conclusion these data show that the quick COVID-19 Severity Index provides easily accessed risk stratication relevant to Emergency Department provider.

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Meticillin-resistant Staphylococcus aureus blood isolates from the emergency department of a tertiary-care hospital in South Korea

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2008.09.019 ◽

2009 ◽

Vol 33 (3) ◽

pp. 293-294

Author(s):

Kwan Soo Ko ◽

Mi Young Lee ◽

Jin Yang Baek ◽

Eun Kang ◽

Hye Jin Roh ◽

...

Keyword(s):

Emergency Department ◽

Staphylococcus Aureus ◽

South Korea ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital

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Data-driven quality improvement in the Emergency Department at a level one trauma and tertiary care hospital

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2005.07.007 ◽

2006 ◽

Vol 30 (3) ◽

pp. 269-276 ◽

Cited By ~ 15

Author(s):

Shari J. Welch ◽

Todd L. Allen

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Data Driven ◽

Care Hospital

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Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.icon-2022.5785 ◽

2021 ◽

Vol 38 (ICON-2022) ◽

Author(s):

Syed Ghazanfar Saleem ◽

Saima Ali ◽

Nida Ghouri ◽

Quratulain Maroof ◽

Muhammad Imran Jamal ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Patient Perception ◽

Care Hospital ◽

Structured Interviews ◽

Privacy Concerns ◽

Creative Commons ◽

Privacy And Confidentiality ◽

And Behavior

Background and Objective: Maintaining privacy and ensuring confidentiality with patients is paramount to developing an effective patient-provider relationship. This is often challenging in over-crowded Emergency Departments (EDs). This survey was designed to explore patients’ perceptions on maintenance of privacy and confidentiality and their subsequent interactions with providers in a busy tertiary care hospital in Karachi. Methods: Trained nursing staff conducted structured interviews with 571 patients who presented to The Indus Hospital (TIH) ED from January to December 2020. All patients were 14 years of age or older, could speak and understand Urdu, and provide informed consent. Patients were asked about their perceptions of privacy and confidentiality in the ED and whether this affected their interactions with providers. Results: Respondents were primarily men (64%) under the age of 45 (62%) presenting for the first time (49%). The majority of patients felt that privacy and confidentiality were maintained, however 10% of patients reported that they had rejected examination due to privacy concerns and 15% of patients reported that they had changed or omitted information provided to a provider due to confidentiality concerns. There was correlation between privacy and confidentiality concerns and patient-provider interactions (p<0.0001). Conclusions: Despite the often over-crowded and busy environment of the ED, patients generally felt that privacy and confidentiality were maintained. Given the correlation between perception and behavior and the importance of an effective patient-provider relationship, particularly in the acute setting when morbidity and mortality is high, initiatives that focus on maintaining privacy and confidentiality should be pursued. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 How to cite this:Saleem SG, Ali S, Ghouri N, Maroof Q, Jamal MI, Aziz T, et al. Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(2):351-355. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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