scholarly journals MP008: Quick to be seen; quick to come back: does first visit CTAS-category predict admission for unplanned returns?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S68-S69
Author(s):  
D. Lewis ◽  
P.R. Atkinson ◽  
J. Fraser ◽  
M. Howlett
Keyword(s):  
Quality Indicator ◽  
Tertiary Care ◽  
Admission Rate ◽  
Care Hospital ◽  
Exact Test ◽  
Admission Rates ◽  
Triage Category ◽  
Important Quality ◽  
Return Visits ◽  
To Come

Introduction: The percentage of unplanned return visits (URV) to the Emergency Department (ED) within 48 or 72 hours of discharge that result in an admission to hospital has been recommended as the top Canadian ED patient safety quality indicator. International data exists although inconsistences exist in the way URV are defined and measured. To our knowledge there are no published Canadian data on the percentage of ED URV admissions. This study examines our own URV data and in particular the correlation between URV admission rates and first visit Canadian Triage Acuity Scale (CTAS) category. Methods: A retrospective analysis of 12-month’s data (January - December 2015) was completed for URV to the ED of a 445 bed regional tertiary care adult and pediatric teaching hospital with 57,000 annual attendances. URV was defined as any patient registering within 72 hours of an earlier visit that had resulted in a discharge from ED. Planned return visits were excluded. The data was analysed for an overall URV percentage, UV percentage by first visit CTAS category, overall percentage of URV admitted and URV admission percentage by first visit CTAS category. Pearson R correlation and Fishers Exact Test were used to test the relationship. Results: During the 12-month period there were 57,025 registrations of which 46,793 patients were discharged. There were 3566 URV (7.62% of those discharged); the number of URV admitted was 532 (1.14 % of those discharged). The return rate/admission rates by CTAS category were: CTAS 1: 6.74%/1.55%; CTAS 2: 7.86%/1.92%; CTAS 3: 8.54%/1.35%; CTAS 4: 5.99%/0.40%; CTAS 5: 5.55%/0.27%. The RR of admission on return for discharged CTAS groups 1 and 2, compared with CTAS 3, 4 and 5 was 1.90 (95 CI 1.57 to 2.30; p<0.0001). Rate of admission on return was negatively correlated with initial CTAS level (Pearson r = -0.89 (95 CI -0.99 to -0.03); R2=0.79; F=11.25; p=0.04). Conclusion: We have demonstrated a relationship between first visit CTAS category and the unplanned return admission rate. If admission is taken as a marker of illness severity, then the likelihood of an inappropriate discharge is inversely proportional to first visit CTAS score. While this makes sense intuitively, our data confirms this relationship in a Canadian tertiary care hospital and supports the reporting of ED URV admission data by first visit triage category as an important quality indicator.

Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamshed Ali ◽  
Osman Faheem ◽  
Pirbhat Shams ◽  
ghufran adnan ◽  
Maria Khan
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Electronic Record ◽  
Medical Attention ◽  
Care Hospital ◽  
Record System ◽  
Admission Rates ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

FACTORS CAUSING DELAY IN TIME TO DOOR AT EMERGENCY DEPARTMENT(ED) IN CASES OF ACUTE STROKE AND IT'S IMPACT ON OUTCOME AT TERTIARY CARE CENTRE

2020 ◽  
pp. 67-70
Author(s):  
Yogender Kumar Yadav ◽  
Dina J Shah ◽  
Jyoti B Sharma ◽  
Nalini Bala Pandey
Keyword(s):  
Acute Stroke ◽  
Average Length ◽  
Tertiary Care ◽  
Onset Time ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
End Points ◽  
Exact Test

BACKGROUND: The effectiveness of stroke management is highly dependent on post onset time of treatment. The study hypothesized that perceptual, social and behavioral factors affect delay in seeking help after symptom onset and worsen the outcome and recovery. OBJECTIVE: To look at the causes of delay in arrival to denitive care hospital ED after symptoms of acute stoke and its impact on patient's clinical outcome. METHODS: An observational prospective study conducted on 63 patients with signs and symptoms of acute stroke (CPSS/NIHSS positive) reported to ED. Reasons for delay in arrival to ED observed. Patients divided into two groups, those who came within 4.5 hours of onset of acute stroke symptoms and those who came after 4.5 hours. Impact of delay on patient's outcome studied at time of discharge as primary end-points in terms of average length of stay (ALOS), complications and death. Secondary end-points evaluate in terms of improvement, deterioration and death within 30th day. Statistical analysis using Chi-square or Fisher's exact test applied to compare both the groups. Odds ratio with 95 % condence limit was also calculated. RESULTS: There were multiple overlapping causes of delay; most frequently was “rst went to physician who doesn't treat stroke (8; 38.1%) and non-availability of nearby stroke centre (8; 38.1%)”. Total 21 (33.34%) patients came after window period (4.5hours). Primary endpoints in terms of ALOS (8 days compared to 9 days, p=0.48), complications (OR=1.4, 95%CI:0.2-8.8, p=0.74) and death (OR=3, 95%CI:0.4-19.3, p=0.24) at time of discharge. Secondary endpoints in terms of improvement (OR=2.8, 95%CI:1.0-7.8, p=0.03), deterioration (OR=6.0, 95%CI:1.4-24.5, p=0.01) and death within 30 days (OR=1.2, 95%CI:0.2-5.5, p=0.81). CONCLUSION: Inadequate knowledge of stroke identication and management causes delay in arrival to hospital. This delay can cause signicant impact on patient outcome and recovery

scholarly journals Upright kneeling position during second stage of labor: a pilot study

2018 ◽  
Vol 7 (2) ◽  
pp. 401 ◽  
Author(s):  
Anjali Dabral ◽  
Pallavi Pawar ◽  
Rekha Bharti ◽  
Archana Kumari ◽  
Achla Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
North India ◽  
Care Hospital ◽  
Apgar Scores ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Perineal Tears ◽  
Second Stage Of Labour

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

scholarly journals Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 680
Author(s):  
Hanif Haspi Harun ◽  
Muhammad Khalis Abdul Karim ◽  
Mohd Amiruddin Abd Rahman ◽  
Hairil Rashmizal Abdul Razak ◽  
Iza Nurzawani Che Isa ◽  
...  
Keyword(s):  
Body Size ◽  
Quality Indicator ◽  
Tertiary Care ◽  
Pulmonary Arteries ◽  
The Body ◽  
Care Hospital ◽  
Diagnostic Reference Levels ◽  
Ct Scanner ◽  
Reference Levels ◽  
Dose Length Product

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14–19 cm), P2 (19–24 cm), and P3 (24–31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries—the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

scholarly journals 2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S727-S727
Author(s):  
Romanee Chaiwarith ◽  
Wisarut Supparatpinyo
Keyword(s):  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chiang Mai ◽  
Chi Square ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

scholarly journals An Evaluation of a Modified CTAS at an Accident and Emergency Department in a Developing Country

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Shalini Pooransingh ◽  
L. K. Teja Boppana ◽  
Isaac Dialsingh
Keyword(s):  
Emergency Department ◽  
Admission Rate ◽  
Cross Sectional Study ◽  
Structural Factors ◽  
Cross Sectional ◽  
Admission Rates ◽  
Accident And Emergency ◽  
Triage Category ◽  
Accident And Emergency Department ◽  
Design And Methods

Objectives. To review the modified Canadian Triage and Acuity Scale used in an accident and emergency department in Trinidad and Tobago. Design and Methods. A cross-sectional study was carried out. Times from assignment of triage category to being seen by a physician were collected from the patient notes on the days of presentation and compared to the reference standards. Times from decision to admit to obtaining a bed were also recorded. Results. 200 patients were included in the study. The median waiting time for patients in the immediate/blue category was 3 minutes (range = 3); for the red category, it was 31.2 minutes (range = 121.8); in the yellow category, it was 61.8 minutes (range = 805.2). The overall admission rate was 30.5%, with an admission rate of 25% for the blue category; 20% of patients in the red category waited more than 4 hours for a hospital bed. Conclusion. The patients assigned to the blue category were being seen almost immediately. Less critical persons wait longer than the reference times and this may be due to structural factors such as staffing. The admission rates per category highlighted a low admission rate for the blue category (25%), which is unusual. This study highlights the need for a further study to review clinical presentation, assignment to triage category, and outcomes.

scholarly journals Knowledge, Attitude and Beliefs of Parents Regarding Fever in Children

2021 ◽  
pp. 33-40
Author(s):  
S. Dhanya Dedeepya ◽  
Vidhyasagar Krishnamoorthy ◽  
P. Ambikapathy
Keyword(s):  
Tertiary Care ◽  
Parental Knowledge ◽  
Febrile Seizures ◽  
Cross Sectional Study ◽  
Outpatient Department ◽  
Medical Attention ◽  
Care Hospital ◽  
Cross Sectional ◽  
To Come ◽  
At Home

Aim: To assess the knowledge, attitude and belief of Parents about fever in their children and how they respond to it while at home and when they seek medical attention. Objectives: The purpose of this study is to know the preexisting knowledge of parents about fever in their children and to impart additional knowledge to them. Materials and Methods: A Cross- Sectional study in the form of a questionnaire was conducted at a tertiary care hospital among parents of children visiting the outpatient department and those admitted as inpatient with fever. Children who presented to the emergency room and those with chronic illnesses were not included. Majority of the primary caregivers was the child's mother, and family becomes the 1st point of contact for the intervention, hence we chose family. As per our department that at least 80% of children were primarily brought to OP for fever, and 90% of those admitted in wards were for febrile illnesses, with or without other associated problems, we asked the statistician to come up with an adequate number and we were given.  Results: A total of 100 parents were selected and interviewed. The informants were mostly mothers (83%). Most of the children were brought to outpatient department within the first five days of onset of fever (68%). The parents said that they confirmed the fever by touch(86%)and most of them prefer to consult the pediatrician before giving any medication (56%).The most common symptoms which were seen associated with fever are cough, cold  and  running nose (54%).The most common cause for worry amongst parents are complications like febrile seizures (43%). Conclusion: Fever is one of the most common complaints with which patients come to the hospital. Majority of parents in this study do not have the practice of documenting fever at home with a thermometer. Inadequate parental knowledge about the nature of fever can lead to poor management. Appropriate education helps them to take appropriate measures when their child develops fever.

scholarly journals Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital

2021 ◽  
pp. 025371762110221
Author(s):  
Nisha K. Prajapati ◽  
Nimesh C. Parikh ◽  
Nilima D. Shah ◽  
Vinodkumar M. Darji ◽  
Heena B. Jariwala ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Psychiatric Morbidity ◽  
Adjustment Disorder ◽  
P Value ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Liaison Psychiatry ◽  
Exact Test ◽  
Consultation Liaison Psychiatry

Background: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. Method: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal–Wallis test, and fisher exact test. Results: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. Conclusions: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

scholarly journals Placental pathology in intrauterine fetal death

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2376-2380
Author(s):  
Nanda J. Patil ◽  
Jyoti S. Tele ◽  
Rohit S. Kadam ◽  
Pawar S. J ◽  
Sujata M. Kumbar
Keyword(s):  
Fetal Death ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Mirror Image ◽  
Intrauterine Fetal Death ◽  
Care Hospital ◽  
Placental Pathology ◽  
Cross Sectional ◽  
Present Cross Sectional Study ◽  
To Come

Placenta is the most accessible and readily evaluable specimen which is mirror image of pregnancy. The objective here is to study the histomorphological changes in placenta in cases of intrauterine fetal deaths and to study correlation of placental findings with causes of fetal death which is significant to understand. The present cross sectional study was carried out in Department of Pathology of a tertiary care hospital from June 2015 to May 2017. Study of Placental Pathology in Intrauterine Fetal Death cases comprised of 99 placentas. The present study was undertaken to study the placental pathology in cases of intrauterine fetal death. IUFD was found to be more common in primigravida 50/99 (50.50%) mothers. Placental study gives useful morphological information regarding the abnormality of pregnancy. Gross and microscopic examination of the placenta plays an important role in identifying the underlying causes of fetal death and helps prevent further recurrence by making appropriate interventions during the next pregnancy. Study of placental pathology gives clues to events occurring throughout gestation and can potentially help to answer, questions concerning pregnancy management and risk assessment of future pregnancies. It will help the researchers who are doing the research in the field of placental pathology in the days to come.

scholarly journals Health care provided to asylum-seeking and non-asylum-seeking paediatric patients at a Swiss tertiary hospital

2019 ◽  
Author(s):  
Julia Regina Brandenberger ◽  
Christian Pohl ◽  
Florian Vogt ◽  
Thorkild Tylleskär ◽  
Nicole Ritz
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Admission Rates ◽  
Number Of Visits

Abstract Background & Methods To compare health care provided to asylum-seeking and non-asylum-seeking children, we performed a cross-sectional study in a paediatric tertiary care hospital in Switzerland. Patients were identified using administrative and medical electronic health records from January 2016 - December 2017. Results A total of 202’316 visits by 55’789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) patients. The emergency department had the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64’315/200’642) respectively. Hospital admissions were more common in asylum-seeking patients 11% (184/1674) and 7% (14’692/200’642). Frequent visits accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49’886/200’642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients and was less frequently used in asylum-seeking children. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that asylum-seeking patients may present with more complex diseases.

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