Case stories and Post-violence behavior of women seeking medical attention at the emergency department due to physical violence

2021 ◽  
Vol 80 ◽  
pp. 102174
Author(s):  
Ayse Kilic Ucar ◽  
Havva Ozdemir ◽  
Gulten Guvenc ◽  
Aygul Akyuz
Keyword(s):  
Emergency Department ◽  
Physical Violence ◽  
Medical Attention ◽  
Case Stories

scholarly journals The use of a dedicated neurological triage system improves process times and resource utilization: a prospective observational study from an interdisciplinary emergency department

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Hans-Werner Rausch ◽  
Angelika Alonso ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Resource Utilization ◽  
Prospective Observational Study ◽  
Neurological Symptoms ◽  
Medical Attention ◽  
Triage System ◽  
Treatment Processes ◽  
Associated Symptoms ◽  
Hospital Resources ◽  
Laboratory Examinations

Abstract Background Patients with neurological symptoms have been contributing to the increasing rates of emergency department (ED) utilization in recent years. Existing triage systems represent neurological symptoms rather crudely, neglecting subtler but relevant aspects like temporal evolution or associated symptoms. A designated neurological triage system could positively impact patient safety by identifying patients with urgent need for medical attention and prevent inadequate utilization of ED and hospital resources. Methods We compared basic demographic information, chief complaint/presenting symptom, door-to-doctor time and length of stay (LOS) as well as utilization of ED resources of patients presenting with neurological symptoms or complaints during a one-month period before as well as after the introduction of the Heidelberg Neurological Triage System (HEINTS) in our interdisciplinary ED. In a second step, we compared diagnostic and treatment processes for both time periods according to assigned acuity. Results During the two assessment periods, 299 and 300 patients were evaluated by a neurologist, respectively. While demographic features were similar for both groups, overall LOS (p < 0.001) was significantly shorter, while CT (p = 0.023), laboratory examinations (p = 0.006), ECG (p = 0.011) and consultations (p = 0.004) were performed significantly less often when assessing with HEINTS. When considering acuity, an epileptic seizure was less frequently evaluated as acute with HEINTS than in the pre-HEINTS phase (p = 0.002), while vertigo patients were significantly more often rated as acute with HEINTS (p < 0.001). In all cases rated as acute, door-to-doctor-time (DDT) decreased from 41.0 min to 17.7 min (p < 0.001), and treatment duration decreased from 304.3 min to 149.4 min (p < 0.001) after introduction of HEINTS triage. Conclusion A dedicated triage system for patients with neurological complaints reduces DDT, LOS and ED resource utilization, thereby improving ED diagnostic and treatment processes.

Consent for Medical Services for Children and Adolescents

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 290-291
Author(s):  
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Routine Care ◽  
Emergency Department Visits ◽  
Medical Attention ◽  
Unaccompanied Minors ◽  
Sexually Transmitted ◽  
Practical Guidelines ◽  
Societal Changes ◽  
Definition Of

Major societal changes affecting the provision of child health care have occurred over the last few decades. In the area of emergency services, consent for medical treatment is an important issue. The purpose of this statement is to outline major considerations involving consent and provide the physician with practical guidelines concerning this issue. Today fewer than one third of children live in two-parent families in which only the father works outside the home.1,2 Because of foster care placement, or temporary or permanent arrangements with relatives or friends, parents may not be available to give consent for treatment of their children.3-6 Unaccompanied minors may seek medical attention in any one of a number of locations. Some go to the emergency department, 14% of which have no policy regarding consent for the care of these patients.7 Unaccompanied minors younger than 18 years of age account for 3.4% of all emergency department visits.7 Twenty-two states and the District of Columbia now have laws concerning the "mture minor." Most other states have provisions in which competent minors may arrange for care involving contraceptives, pregnancy, abortion, sexually transmitted diseases, drug and alcohol abuse, and psychiatric disorders.8 The dilemma for emergency physicians and practicing pediatricians alike is whether to follow a strict interpretation of the law or to adopt a more practical approach. Clearly, consent is not required in life- or limb-threatening emergencies,8,9 although the definition of emergency varies from state to state. However, in most instances, only routine care, not emergency care, is needed. As a result, many physicians fear charges of battery or litigation should their judgement regarding treatment be questioned.8

scholarly journals Delineamento da violência sofrida pela equipe de enfermagem na emergência hospitalar [Outline of violence suffered by the hospital emergency department nursing team] [Diseño de la violencia sufrida por el equipo de enfermería en las urgencias hospitalarias]

2018 ◽  
Vol 26 ◽  
pp. e26877
Author(s):  
Ana Paula Da Fonseca da Costa Fernandes ◽  
Joanir Pereira Passos
Keyword(s):  
Emergency Department ◽  
Rio De Janeiro ◽  
Physical Violence ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
System Method ◽  
Analysis Technique ◽  
Nursing Team ◽  
Qualitative Descriptive ◽  
Nursing Professionals

Objetivo: caracterizar, na visão do profissional de enfermagem, a violência sofrida a partir da sua relação com o usuário ou acompanhante/visita do sistema público de saúde em um serviço de emergência hospitalar. Método: trata-se de recorte de estudo qualitativo, descritivo, utilizando a técnica de análise de conteúdo, por meio de entrevista com 24 profissionais de enfermagem que trabalhavam na emergência de um hospital público de grande porte no Rio de Janeiro, em 2012. Projeto aprovado por Comitê de Ética em Pesquisa. Resultados: emergiram quatro categorias, nas quais foram identificadas violência verbal e física, verificando também seu caráter multifatorial. Conclusão: foram encontrados problemas relacionados à gestão hospitalar como fator desencadeador da violência, tendo o manejo do profissional de enfermagem para esta situação o seu principal atenuante/agravante. Devido à subnotificação, estudos na área auxiliam a tomada de medidas de promoção e proteção da saúde do profissional de enfermagem.ABSTRACTObjective: from the nursing team’s viewpoint, to characterize the violence suffered in their relationship with users or companions/visitors in a hospital emergency department of the public health system. Method: this is a portion of a qualitative, descriptive study using content analysis technique, by interview of 24 nursing professionals working in the emergency department of a public hospital in Rio de Janeiro in 2012. The study was approved by the research ethics committee. Results: verbal and physical violence were identified in the four categories that emerged, which were also found to be multifactorial. Conclusion: problems were found relating to hospital management as a factor in triggering violence, the main mitigating/aggravating factor being management of the nursing team for this situation. Because of underreporting, studies in this area are helpful when taking measures to promote and protect nurses’ health.RESUMENObjetivo: caracterizar, desde el punto de vista del profesional de enfermería, la violencia sufrida desde su relación con el usuario o acompañante/visitante del sistema público de salud en un servicio de urgencias hospitalarias. Método: se trata de recorte de un estudio cualitativo, descriptivo, utilizando la técnica de análisis de contenido, a través de entrevistas con 24 profesionales de enfermería que trabajan en el servicio de urgencias de un hospital público en Rio de Janeiro, en 2012. Proyecto aprobado por el Comité de Ética en Investigación. Resultados: emergieron cuatro categorías, donde fueron identificados violencia verbal y física, verificando su carácter multifactorial. Conclusión: se han encontrado problemas relacionados con la gestión hospitalaria como factor desencadenante de violencia, el manejo del profesional de enfermería para esta situación siendo su principal atenuante/agravante. Debido a la subnotificación, estudios en el área ayudan a tomar medidas de promoción y protección de la salud de los profesionales de enfermería.

scholarly journals Secular trends in emergency department encounters for concussion at US children's hospitals by age group (2008–2017)

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S22.2-S22
Author(s):  
Amy Linabery ◽  
Kara Seaton ◽  
Alicia Zagel ◽  
Alicen Spaulding ◽  
Gretchen Cutler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Public Awareness ◽  
Weighted Least Squares ◽  
Age Groups ◽  
Secular Trends ◽  
Medical Attention ◽  
Age Group ◽  
Admission Rates ◽  
Pediatric Hospitals ◽  
Over Time

BackgroundIncreased concussion rates in US youth have been documented since 2000. Concomitant rises in healthcare utilization for concussion are likely attributable to public health, media, and legislative initiatives aimed at increasing public awareness of the importance of seeking medical attention after injury. Utilization trends in young children have not been well-documented, however.ObjectiveTo characterize recent secular trends in pediatric emergency department (ED) encounters for concussion by 4-year age group.MethodsUsing Children's Hospital Association's Pediatric Health Information System data, we examined a retrospective cohort of patients aged 2–17 years with an ED encounter for concussion at 22 US pediatric hospitals with continuous data between 2008 and 2017. Average annual change in rates of ED visits for concussion and sports-/recreation-related concussion, imaging, and admissions were estimated via weighted least-squares regression.ResultsED encounters with a primary indication of concussion comprised 0.8% (n = 86,393) of all ED encounters in 2008–2017. Over time, ED concussion visits in 6–17-year-olds increased by 0.5–1.1 per 1,000 ED encounters per year (all Ptrend< 0.0001), while rates among 2-5-year-olds remained stable (Ptrend = 0.72). Rates for sports-/recreation-related concussions increased significantly across all age groups (<0.0001 ≤ Ptrend ≤ 0.01). Absolute number undergoing any imaging increased in all age groups; however, due to increased ED concussion encounters, the rate of imaging decreased overall (−29.7/1,000 ED concussion encounters/year; Ptrend < 0.0001) and across all age groups; the imaging rate decreased less for 2-5-year-olds (−19.6/1,000 encounters/year; Ptrend < 0.0001). Likewise, admission rates declined significantly over time overall (−10.1/1,000 encounters/y; Ptrend = 0.0006) and for all age groups.ConclusionsED concussion encounter rates in US youth aged 6–17 years continue to increase at pediatric hospitals, suggesting awareness efforts have been effective. Conversely, imaging and admission rates have decreased, indicating efforts to curtail unnecessary irradiation and intervention have also been successful. Trends in 2-5-year-olds were somewhat different from older youth and should be explored further.

scholarly journals Young victims of youth violence: using youth workers in the emergency department to facilitate ‘teachable moments’ and to improve access to services

2020 ◽  
pp. edpract-2019-318251
Author(s):  
Elizabeth Wortley ◽  
Ann Hagell
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Youth Violence ◽  
Healthcare Workers ◽  
Physical Violence ◽  
Rapid Review ◽  
Youth Workers ◽  
Access To Services ◽  
The Uk ◽  
Improve Access

There have been rising concerns in the UK about the levels of serious violence between young people, especially serious physical violence and knife crime. Interactions with young people in the emergency department (ED) at the time of injury provide an opportunity for screening and intervention in order to reduce the risk of repeat attendances. However, paediatricians and other healthcare workers can feel unsure about the best way to intervene. Embedding youth workers in EDs has started in some UK hospitals, making use of a potential ‘teachable moment’ in the immediate aftermath of an event to help change behaviour. Based on a rapid review of the literature, we summarise the evidence for these types of interventions and present two practice examples. Finally, we discuss how EDs could approach the embedding of youth workers within their department and considerations required for this.

scholarly journals Risk Factors of Recurrent Falls Among Older Adults Admitted to the Trauma Surgery Department

2020 ◽  
Vol 11 ◽  
pp. 215145932094316
Author(s):  
William Curran-Groome ◽  
Gary Klein ◽  
Stanton B. Miller ◽  
Azor Hui ◽  
Jordan S. Wilson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Emergency Department ◽  
Older Adult ◽  
Trauma Surgery ◽  
Intervention Strategies ◽  
Medical Attention ◽  
Recurrent Falls ◽  
Surgery Department ◽  
First 90 Days

Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion of recurrent falls among older adults appear to occur within a few months and are statistically related to identifiable risk factors. Prevention and intervention strategies, delivered either during treatment for an initial fall or upon discharge from an inpatient admission, may reduce the incidence of recurrent falls among this population.

scholarly journals Psychiatric liaison referrals: a thematic analysis during peak COVID-19

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S294-S294
Author(s):  
Kaj Svedberg ◽  
William Hancox ◽  
Hugh Grant-Peterkin
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Careful Consideration ◽  
University Hospital ◽  
Medical Attention ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Low Mood ◽  
Crisis Care

AimsWith the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.MethodAll referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.Result14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.ConclusionAlthough themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.

scholarly journals MP05: Injuries in refugee children presenting to a paediatric emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S41-S42
Author(s):  
E. Zhang ◽  
F. Razik ◽  
S. Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Refugee Children ◽  
Medical Attention ◽  
Care Providers ◽  
Ed Visits

Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.

scholarly journals FALL INJURY CHARACTERISTICS ASSOCIATED WITH EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS AMONG OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S495-S495
Author(s):  
Namkee G Choi ◽  
Diana M DiNitto ◽  
Mark E Kunik
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Fall Prevention ◽  
Emergency Department Visits ◽  
The Body ◽  
Medical Attention ◽  
Healthcare Use ◽  
Fall Injuries ◽  
Injury Characteristics ◽  
Fall Injury

Abstract Fall injuries and related healthcare use among older adults are increasing in the US. Based on the 2013-2017 US National Health Interview Survey public use data, this study examined fall injury characteristics that are associated with emergency department (ED) visits and hospitalizations among those aged ≥60 years who received medical attention for their fall injuries within a 91-day reference period (N=1,840). Our findings show that nearly a third of these older adults received care from emergency medical services (EMS), presumably for a “lift assist” to get off the floor and/or for ED or hospital transport; a little more than one-third had an ED visit only; and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that hip and head injuries, face injuries, and broken bones/fractures (from any type of injury) were likelier causes of hospitalization than injuries to other parts of the body. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization, while fall injuries that occurred away from home and those with lung disease and memory problems were associated with higher risk of ED use only. These healthcare use data indicate the significant toll that fall injuries exact upon older adults and healthcare system. Fall prevention programs should target risk factors that are specific to serious injuries and be made more accessible. Strategies for implementing scalable, adaptable, and measurable fall prevention models by EMS providers and ED staff are also needed.

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