scholarly journals P042: Are we ready for a gunman in the emergency department? A qualitative study of staff perceptions of personal health risks, workplace safety, and individual and institutional readiness to respond to “code silver”

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S92
Author(s):  
K. Dainty ◽  
M. Seaton ◽  
M. McGowan ◽  
S.H. Gray
Keyword(s):  
Data Analysis ◽  
Qualitative Study ◽  
Tertiary Care ◽  
Workplace Safety ◽  
Hospital Staff ◽  
Personal Health ◽  
Active Shooter ◽  
Tertiary Care Centre ◽  
Staff Members ◽  
The Impact

Introduction: Hospital-based gun violence is devastatingly traumatic for everyone present and quite tragically on the rise. The Ontario Hospital Association (OHA) has recently designated active shooter situations as “Code Silver” and advised member hospitals to develop policies and train health care workers on how best to respond. Given that emergency departments (ED) are particularly susceptible to opportunistic breach by an active shooter and staff members are likely to be called upon as first responders, the impact of a Code Silver on ED functioning and staff members may be particularly severe. We hypothesized that there may not be a simple, one-size-fits-all-hospital-staff solution about how best to prepare ED physicians and staff to respond to a Code Silver situation. Methods: In order to inform and support future staff training initiatives related to Code Silver and other disaster situations in hospitals, we conducted a robust qualitative study to investigate perspectives and behaviour related to personal safety at work and Code Silver in particular among the multi-disciplinary ED staff at a single tertiary care centre in Toronto, Ontario. Participants for in-depth interviews and focus groups were recruited using a combination of stakeholder and maximum variation sampling strategies. Data analysis occurred in conjunction with data collection and standard thematic analysis techniques were employed. Results: Initial data analysis has revealed the following thematic concepts: the ubiquitous banality of personal health risk as an expected, acceptable feature of everyday life at work for ED staff, the perception of active shooters as a transgressive threat that violates the boundaries of professional responsibility, and the perceived fallacy of “readiness” to respond to disastrous situations. A fulsome analysis will be ready for presentation in June. Conclusion: Knowledge from this study indicates that ED staff members have unique and specific training needs in relation to an active shooter situation, and gives us deeper insight into potential areas of focus for training and opportunities for knowledge translation on the topic of Code Silver for EDs across the country.

scholarly journals P025: Are we ready for a gunman in the emergency department? A qualitative study of staff perceptions of risk and readiness to respond

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S65-S66
Author(s):  
M. McGowan ◽  
K. Dainty ◽  
B. Seaton ◽  
S. Gray
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
Workplace Violence ◽  
Tertiary Care ◽  
Active Shooter ◽  
Tertiary Care Centre ◽  
Primary Methods ◽  
Staff Members ◽  
Qualitative Interview Study ◽  
The Impact

Introduction: Hospital-based gun violence is devastatingly traumatic for everyone present and recent events in Cobourg, Ontario underscore that an active shooter inside the emergency department (ED) is an imminent threat. In June 2016, the Ontario Hospital Association (OHA) added Code Silver to the list of standardized emergency preparedness colour codes and advised member hospitals to develop policies and train staff on how best to respond. Given that EDs are particularly susceptible to opportunistic breach by an active shooter, the impact of a Code Silver on ED functioning and staff members may be particularly acute. We hypothesized that there may not be a simple, one-size-fits-all-hospital-staff solution about how best to prepare EDs to respond to Code Silver. In order to inform and support future staff training initiatives related to Code Silver and other disaster situations in hospitals, we sought to investigate staff perspectives and behaviour related to personal safety at work and, in particular, an active shooter. Methods: We undertook a qualitative interview study of multi-disciplinary ED staff (MDs, RNs, clericals, allied health, administrators) at a single tertiary care centre in Toronto. The primary methods for data collection were in-depth qualitative interviews and focus groups. Participants were recruited using stakeholder and maximum variation sampling strategies. Data collection and analysis were concurrent and standard thematic analysis techniques were employed. Results: Sixteen (16) staff members participated in interviews and 40 participated in small focus group discussions. Data analysis revealed workplace violence and personal health risks have been normalized as expected, acceptable features of everyday life at work in the ED given that patients are perceived to be sick people in need of help that ED staff are trained for and prepared to provide. In contrast, weapons and active shooters challenge the boundaries of professional responsibility and readiness to respond to Code Silver is perceived by staff as a fallacy. Conclusion: Knowledge from this study gives us crucial insight into important areas for targeted training and opportunities for knowledge translation on the topic of implementing Code Silver in EDs across the country. Future interventions must include how to overcome normalization of workplace violence in the ED setting and negotiating competing professional obligations during crisis situations. Attention to these are crucial if we are to truly keep our staff safe during these traumatic events.

scholarly journals Impact of COVID-19 pandemic on stroke admissions in Qatar

2021 ◽  
Vol 3 (1) ◽  
pp. e000084
Author(s):  
Naveed Akhtar ◽  
Salman Al Jerdi ◽  
Ziyad Mahfoud ◽  
Yahia Imam ◽  
Saadat Kamran ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Small Vessel Disease ◽  
Tertiary Care ◽  
Relative Increase ◽  
Large Vessel ◽  
Tertiary Care Centre ◽  
Transient Ischaemic Attacks ◽  
Stroke Mimics ◽  
Coronary Syndromes ◽  
The Impact

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

CLINICAL PROFILE OF OUTPATIENTS ATTENDING DERMATOLOGY DEPARTMENT DURING COVID-19 LOCKDOWN RELAXATION PERIOD IN A TERTIARY CARE CENTRE IN SOUTH INDIA – A CROSS-SECTIONAL ANALYTICAL STUDY

2021 ◽  
pp. 13-16
Author(s):  
Afthab Jameela Wahab ◽  
Pavithra Gunasekaran ◽  
P. Mohan ◽  
V. Sudha ◽  
L. Balamurugan ◽  
...  
Keyword(s):  
South India ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Relaxation Period ◽  
Number Of Patients ◽  
Outpatient Practice ◽  
The Impact

Background - The cutaneous manifestations of the novel coronavirus have been well documented. However, there are few studies that relate to the clinical prole of regular dermatology outpatients seeking treatment during the lockdown relaxation period braving the pandemic. With the Aim - view to determine the changes seen in dermatology outpatient practice, this study analysed the clinical prole of new patients attending the Dermatology Outpatient Department (OPD) during the COVID-19 lockdown relaxation period in a tertiary care centre in a metropolitan suburb in South India. New dermatology outpatients during the months of May, June, July and August Method - 2020 were included in the study. Outpatient data for this period was analysed and compared with corresponding data for the same period in the previous two years. There was a Result – decrease in the OP census, number of patients in the extremes of life as well as those with asymptomatic dermatoses. There was an increase in the number of patients with infections, particularly dermatophytosis. There was also a noteworthy absence of dermatological emergencies. Conclusion - In essence, our study shows the impact of COVID-19 pandemic on the routine dermatology outpatient services with signicant changes in the clinical prole of outpatient practice following lockdown relaxation.

scholarly journals P73 Trends in ultrasound guided musculoskeletal injections at one tertiary care centre over 6 years

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Kunal Lall ◽  
Vivian Ejindu ◽  
Patrick D. W Kiely
Keyword(s):  
Soft Tissue ◽  
Time Pressure ◽  
Waiting Times ◽  
Tertiary Care ◽  
Fold Increase ◽  
Ultrasound Guided ◽  
Tertiary Care Centre ◽  
The Impact ◽  
Effective Service

Abstract Background Ultrasound (US) has brought many benefits into rheumatologic practice, delivery of targeted injections into joints, bursae and other structures. Whilst many joints may be accurately injected in clinic, guided by clinical landmarks, US permits injections into anatomically less accessible sites. We have assessed trends in the number and type of requests for US guided joint or soft tissue injections from the rheumatology department over the last 6 years, and the impact on waiting times. Methods Details of all requests for US guided joint or soft tissue injections were obtained from the St George’s PACS system from 1 January 2013 - 31 December 2018. Review of patient records was conducted to determine whether the referral was routine or urgent, the waiting time between referral and appointment, the joint or structure to be injected, and whether an injection into the requested site was actually performed. Results Table 1 shows the total number of out-patient attendances in rheumatology per year from 2013 - 2018, the number of referrals for US-guided injection, the proportion requested urgently and waiting times for routine and urgent cases. Over 6 years requests for US guided injections have risen 2.3-fold, from <1% to nearly 2% of all out-patient attendances. Of 1834 requests, no injections were given in 420 instances (23%), due to patient preference or lack of indication at time of US. In 2018 of all joint or tendon/bursa injections initiated in rheumatology, 260 (38%) were given in routine clinic time without delay, and 420 (62%) were requested by US with a delay of over 2 months. Conclusion Over 6 years a 33% increase in out-patient clinic workload has been accompanied by a disproportionate 2.3-fold increase in requests for US guided injections, representing >50% of injections initiated by the service. One explanation may be time pressure in clinic. This trend has not been matched by increased radiology capacity, with urgent requests now waiting >6 weeks. This has implications for quality of care, staffing and effective service delivery. The trend to fewer injections in clinic will continue if clinicians become increasingly reliant on radiology colleagues. Disclosures K. Lall None. V. Ejindu None. P.D.W. Kiely None.

scholarly journals Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2997
Author(s):  
Molina U. Patel ◽  
Yuvraj Jadeja ◽  
Niket Patel ◽  
Nayana Patel ◽  
Smruti Vaishnav ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Case Series ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Significant Difference ◽  
The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

Evaluating the impact of working on the NAF hotline: A qualitative study with former staff members

Contraception ◽  
2020 ◽  
Vol 101 (5) ◽  
pp. 356-357
Author(s):  
A.M. Foster ◽  
S. Frappier ◽  
L. Crich ◽  
K. Messier
Keyword(s):  
Qualitative Study ◽  
Staff Members ◽  
The Impact

scholarly journals Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

2020 ◽  
Vol 8 ◽  
Author(s):  
Ali Akhtar ◽  
Amer Hayat Khan ◽  
Hadzliana Zainal ◽  
Mohamed Azmi Ahmad Hassali ◽  
Irfhan Ali ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Health Care System ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
The Impact ◽  
Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

scholarly journals MP285STUDY ON THE IMPACT OF RENAL STATUS IN THE OUTCOME OF PATIENTS UNDERGOING LIVER TRANSPLANT AT A TERTIARY CARE CENTRE IN SOUTH INDIA

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii531-iii531
Author(s):  
S Talwar ◽  
R Nair ◽  
S Sudhindran ◽  
G Kurian ◽  
A Mathew ◽  
...  
Keyword(s):  
Liver Transplant ◽  
South India ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
The Impact
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