Beirut Blast 2020: Cries and Bloodshed at the Busiest Hospital

2021 ◽  
pp. 1-7
Author(s):  
Anthony Kerbage ◽  
Sara F. Haddad ◽  
Marianne Zoghbi ◽  
Tarek Souaid ◽  
Elio Haroun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ammonium Nitrate ◽  
Emergency Response ◽  
General Ward ◽  
University Hospitals ◽  
Property Damage ◽  
Surge Capacity ◽  
Triage System ◽  
Large Explosion

Abstract On August 4, 2020, Beirut experienced a large explosion when 2750 tons of ammonium nitrate detonated in the Beirut port resulting in more than 220 deaths, 76 000 injuries, 300 000 people displaced, and 15 billion dollars loss in property damage. Hôtel-Dieu de France (HDF), one of the largest university hospitals in the capital, has an emergency department that typically accommodates 25 patients. On that night, it received the largest number of injuries and had to accommodate more than 700 casualties within a few hours of the blast. This article describes HDF’s preparedness, emergency response, as well as the distribution of admissions to the emergency department, operation rooms, and the general ward. Surge capacity and the triage system are also detailed.

scholarly journals Prognostic value of a four-level Chinese emergency triage for an Emergency Department: A prospective cohort study

2019 ◽  
Author(s):  
Wenlong Huang ◽  
Xiaohua Xie ◽  
Haiyan Xiong ◽  
Qiongling Liu ◽  
Tan Wei ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Prognostic Value ◽  
General Ward ◽  
Multivariable Logistic Regression Analysis ◽  
Chinese Government ◽  
Triage System ◽  
Icu Admission ◽  
Triage Level

Abstract Background In order to assign treatment priorities of patients who presenting to emergency departments (ED), various triage scales have been developed around the world. In china, four-tier triage scale was recommended by a national triage guideline that published by the central Chinese government. After that a four-tier triage system, used only in tertiary hospitals in Shenzhen, was published by the Public Hospital Administration of Shenzhen Municipalitfy in August, 2013 (Shenzhen Triage System, SZTS). But the ability in predicting admission and in-hospital mortality with the four-level triage scale for patients presented in emergency department was unclear. This research aimed to assess the prognostic value of the SZTS by examining the association between triage levels and clinical outcomes in adult patients.Methods Patients 18 years of age or older, who were triaged category 1, 2 or 3 in the emergency department (ED) from May 17, 2017 until September 27, 2017, were enrolled. This study evaluated an association between triage level and in-hospital mortality, ICU admission and general ward admission by using multivariable logistic regression analysis. Receiver operating characteristic curves were used to assess the predictive ability of SZTS in determining in-hospital mortality, ICU admission and general ward admission.Results There were 383 patients enrolled in the study. More urgent triage level were significantly related to a higher proportion of in-hospital mortality, ICU admission and general ward admission. The OR for in-hospital mortality (OR 11.6, 95% CI 5.8-22.9, p<0.001), ICU admission (OR 14.4, 95% CI 7.4-27.7, p<0.001) and general ward admission (OR 10.6, 95% CI 1.4-79.2, p=0.022) were greater at triage level 1 compared to triage level 2 and level 3. The AUC for in-hospital mortality, ICU admission and general ward admission prediction of SZTS was 0.838, 0.830 and 0.792, respectively.Conclusions This study suggests that triage levels were associated with general ward admission, ICU admission and in-hospital mortality, and SZTS showed good performance for clinical outcomes prediction.

scholarly journals Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Steffie H. A. Brouns ◽  
Lisette Mignot-Evers ◽  
Floor Derkx ◽  
Suze L. Lambooij ◽  
Jeanne P. Dieleman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Triage System ◽  
Manchester Triage System ◽  
Emergency Department Patients

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

Five-level triage system more effective than three-level in tertiary emergency department

2002 ◽  
Vol 28 (5) ◽  
pp. 395-400 ◽  
Author(s):  
Debbie A. Travers ◽  
Anna E. Waller ◽  
J.Michael Bowling ◽  
Deborah Flowers ◽  
Judith Tintinalli
Keyword(s):  
Emergency Department ◽  
Triage System

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.

Abstract W P269: Collaboration in the Emergency Department Improves Stroke Care

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Julie M Fussner ◽  
Kiefah Awadallah
Keyword(s):  
Emergency Department ◽  
Stroke Patient ◽  
Stroke Care ◽  
Ct Scanner ◽  
Patient Room ◽  
University Hospitals ◽  
Charge Nurse ◽  
Prioritization Process ◽  
Hand Off ◽  
Telephone Calls

Introduction: The purpose of this project is to improve the timeliness of stroke care at University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC). Several projects were implemented in the Emergency Department (ED): Brain Attack (BAT) Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room. Methods: First, the BAT lab project addressed the need to expedite lab results since there was no prioritization of specimens. Working with a multidisciplinary team including the ED Lab Quality committee, a new process was developed for the BAT labs using a colored requisition. Second, the ED Medic role was identified to assist with communication of incoming transfers At UHCSCC communication of all patients arriving by EMS or transfers from other facilities is directed through the UH Transfer Center. With an average of 150 patients arriving per day, this requires 8.1 hours of telephone calls placed to the ED charge nurse a month. Third, documentation of the handoff from transporting personnel was written inconsistently in multiple locations. A standardized hand off form was implemented for the nurse to obtain consistent and readily available information to provide efficient care for the stroke patient. Finally, when a new ED was built in 2011, a dedicated stroke room was designed with an attaching CT scanner to further improve the time of diagnosis for the stroke patient. Results: With the new prioritization process for lab specimens, the turnaround times dramatically improved. Average result times decreased by 23 minutes for CBC, 47 minutes for BMP and 35 minutes for PT/ INR. The Medic role revision decreased the telephone calls placed to the ED charge nurse by 5.5 hours a month to allow more time spent assisting with patient care. Handoff documentation improved from 33% to 90% compliance. Finally, in the new ED with the stroke room attached to the CT scanner, the average time from arrival to CT completion decreased from average of 32 to 20 minutes. Conclusions: The implementation of the BAT Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room projects have all demonstrated that collaboration between the ED and other disciplines has improved the stroke care provided.

Implementing an Emergency Department Information System

2014 ◽  
Vol 6 (1) ◽  
pp. 17-30
Author(s):  
Paraskevas Vezyridis ◽  
Stephen Timmons
Keyword(s):  
Emergency Department ◽  
Information System ◽  
Information And Communication Technologies ◽  
Clinical Information System ◽  
Clinical Information ◽  
Actor Network Theory ◽  
Linear Process ◽  
University Hospitals ◽  
Structured Interviews ◽  
Healthcare Settings

Information and communication technologies (ICT) are increasingly used in healthcare settings. Despite their technical robustness, their implementation has not always been straightforward. This is a case study of the implementation of a clinical information system for patient registration and tracking in the busy emergency department (ED) of a large English NHS University Hospitals Trust. By adopting an Actor-Network Theory (ANT) approach, the authors explore the complex intertwining of people and machines in the local setting as they negotiate the success of the project. Based on the analysis of 30 semi-structured interviews with clinical and administrative staff and, of relevant policy and project documentation, the authors demonstrate how the technologically-mediated transformation of healthcare practices is not a fixed and linear process, but the interplay of various fluctuating, performative and co-constitutive technical and social factors.

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