scholarly journals (A22) Impact of Karachi Terrorist Bombing on an Emergency Department of a Tertiary Care Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s6-s7
Author(s):  
H. Waseem ◽  
S. Shahbaz ◽  
J. Razzak
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Wound Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Disaster Plan ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
The Government

ObjectivesThe objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.MethodsThis was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.ResultsThe results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.ConclusionsThe emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.

scholarly journals P117: A pilot program of physician at triage conducted at a tertiary care hospital improved measures of emergency department throughput and provides a potential solution for emergency department overcrowding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S98-S98
Author(s):  
J. D. Powell ◽  
A. Hughes ◽  
R. Scott ◽  
N. Balfour ◽  
G. McInnes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Administrative Database ◽  
Care Hospital ◽  
Potential Solution ◽  
Process Measures ◽  
Emergency Department Overcrowding ◽  
Number Of Patients

Introduction: Emergency Department Overcrowding (EDOC) is a multifactorial issue that leads to Access Block for patients needing emergency care. Identified as a national problem, patients presenting to a Canadian Emergency Department (ED) at a time of overcrowding have higher rates of admission to hospital and increased seven-day mortality. Using the well accepted input-throughput-output model to study EDOC, current research has focused on throughput as a measure of patient flow, reported as ED length of stay (LOS). In fact, ED LOS and ED beds occupied by inpatients are two “extremely important indicators of EDOC identified by a 2005 survey of Canadian ED directors. One proposed solution to improve ED throughput is to utilize a physician at triage (PAT) to rapidly assess newly arriving patients. In 2017, a pilot PAT program was trialed at Kelowna General Hospital (KGH), a tertiary care hospital, as part of a PDSA cycle. The aim was to mitigate EDOC by improving ED throughput by the end of 2018, to meet the national targets for ED LOS suggested in the 2013 CAEP position statement. Methods: During the fiscal periods 1-6 (April 1 to September 7, 2017) a PAT shift occurred daily from 1000-2200, over four long weekends. ED LOS, time to inpatient bed, time to physician initial assessment (PIA), number of British Columbia Ambulance Service (BCAS) offload delays, and number of patients who left without being seen (LWBS) were extracted from an administrative database. Results were retrospectively analyzed and compared to data from 1000-2200 of non-PAT trial days during the trial periods. Results: Median ED LOS decreased from 3.8 to 3.4 hours for high-acuity patients (CTAS 1-3), from 2.1 to 1.8 hours for low-acuity patients (CTAS 4-5), and from 9.3 to 8.0 hours for all admitted patients. During PAT trial weekends, there was a decrease in the average time to PIA by 65% (from 73 to 26 minutes for CTAS 2-5), average number of daily BCAS offload delays by 39% (from 2.3 to 1.4 delays per day), and number of patients who LWBS from 2.4% to 1.7%. Conclusion: The implementation of PAT was associated with improvements in all five measures of ED throughput, providing a potential solution for EDOC at KGH. ED LOS was reduced compared to non-PAT control days, successfully meeting the suggested national targets. PAT could improve efficiency, resulting in the ability to see more patients in the ED, and increase the quality and safety of ED practice. Next, we hope to prospectively evaluate PAT, continuing to analyze these process measures, perform a cost-benefit analysis, and formally assess ED staff and patient perceptions of the program.

scholarly journals Clinicoepidemiological profile of ear, nose, throat patients in outpatient clinic of tertiary health care facility in Punjab

2020 ◽  
Vol 7 (11) ◽  
pp. 4522
Author(s):  
Manish Munjal ◽  
Anurag Chowdhary ◽  
Harsimran Bhatti ◽  
Porshia Rishi ◽  
Nitika Tuli ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Care Facility ◽  
Health Care Facility ◽  
Neck Surgery ◽  
North India ◽  
Care Hospital ◽  
Number Of Patients

Background: This study evaluated the profile of ailments in patients presenting to outpatient clinic of tertiary care hospital of North India that caters to ENT diseases in population of Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir.Methods: A retrospective study was undertaken by analysing the medical records of patients managed at the department of otorhinolaryngology and head and neck surgery at the tertiary care hospital, Punjab from Jan 2018 to Dec 2018 and all essential data was collected.Results: Total no. of patients presenting to the ENT OPD during the period of assesment were 32,475.  49.30% were males and 50.70 % were females, respectively. 29.70% were children below 15 years. The number of patients presenting per month were 2706, with maximum no. of patients presenting in the month of August to November. Patients with ear diseases were 9280 (28.57%), Nose diseases were 11963 (36.83%), and throat diseases were 11232 (34.58%).Conclusions: This study showed that awareness of ENT ailments and visits for specialised treatment is on the rise rather than primary level treatment at local or general medicine or family physician level.

Emergency General Surgery Regionalization: Retrospective Cohort Study of Emergency General Surgery Patients at a Tertiary Care Center

2021 ◽  
pp. 000313482110385
Author(s):  
Sullivan A. Ayuso ◽  
Sharbel A. Elhage ◽  
Kyle W. Cunningham ◽  
A. Britton Christmas ◽  
Ronald F. Sing ◽  
...  
Keyword(s):  
General Surgery ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographic Origin ◽  
Care Facility ◽  
Care Hospital ◽  
Emergency General Surgery ◽  
Tertiary Care Facility ◽  
Tertiary Care Hospitals

Background Emergency general surgery (EGS) patients presenting at tertiary care hospitals may bypass local hospitals with adequate resources. However, many tertiary care hospitals frequently operate at capacity. We hypothesized that understanding patient geographic origin could identify opportunities for enhanced system triage and optimization and be an important first step for EGS regionalization and care coordination that could potentially lead to improved utilization of resources. Methods We analyzed patient zip code and categorized EGS patients who were cared for at our tertiary care hospital as potentially divertible if the southern region hospital was geographically closer to their home, regional hospital admission (RHA) patients, or local admission (LA) patients if the tertiary care facility was closer. Baseline characteristics and outcomes were compared for RHA and LA patients. Results Of 14 714 EGS patients presenting to the tertiary care hospital, 30.2% were categorized as RHA patients. Overall, 1526 (10.4%) patients required an operation including 527 (34.5%) patients who were potentially divertible. Appendectomy and cholecystectomy comprised 66% of the operations for potentially divertible patients. Length of stay was not significantly different ( P = .06) for RHA patients, but they did have lower measured short-term and long-term mortality when compared to their LA counterparts ( P < .05). Conclusions EGS diagnoses and patient geocode analysis can identify opportunities to optimize regional operating room and bed utilization. Understanding where EGS patients are cared for and factors that influenced care facility will be critical for next steps in developing EGS regionalization within our system.

Assessment of Daily Burden and Factors for Overcrowded Emergency Department at Tertiary Care Hospital of Karachi

2021 ◽  
pp. 30-35
Author(s):  
Arsala Faridi ◽  
Farah Ahmad ◽  
Areej Zehra ◽  
Afreen Fazal
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Patient Flow ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Duration ◽  
Number Of Patients ◽  
Significant Difference

Background: When in emergency room there is no enough area left to serve or to admit the subsequent sick patients who may require urgent attention and observation the setting is called as the overcrowded emergency room. Due to overcrowded emergency department the quality of services provided by the staff and doctors is compromised ultimately patients with severe diseases are ignored and this may be one of the causes for causalities. Objective: To assess the daily burden and factors responsible for overcrowding at emergency department of tertiary care hospital of Karachi. Methodology: It was a cross sectional study conducted at tertiary care hospital of Karachi from October 2020 to January 2021. Data of patients coming to adult emergency department of either gender were collected.  Patients age <14 were excluded as these were referred to pediatric emergency department. Data collection was done according to Canadian emergency department triage and acuity scale (CTAS). Results: Total number (N) of patients who visited emergency department in study duration was 13434. The mean number of patients who visited ED was 141±13during our study duration. There was no any significant difference in presenting complaint. Delay in investigations was found to be a reason of prolong stay and overcrowding in ED in our setting. Conclusion: Overcrowding of patients in our ED of our setting was a common problem. The number of staff, doctors and beds were not matching the number of patient flow in the department. The main reason of prolong stay in ED was delay in investigations.

scholarly journals A Study of Cost incurred in providing Emergency Care Services in an Apex Tertiary Care Hospital

2016 ◽  
Vol 4 (1) ◽  
pp. 45-50
Author(s):  
Neeraj Garg ◽  
Amit Lathwal ◽  
Shakti K Gupta ◽  
Ruchi Garg
Keyword(s):  
Emergency Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Total Cost ◽  
Care Services ◽  
Tertiary Care Facility ◽  
The Cost ◽  
Emergency Care Services

ABSTRACT Introduction An emergency department (ED), also known as accident and emergency (A8E), emergency room (ER), or casualty department, is a medical treatment facility specializing for acute care of patients who present without prior appointment, either by their own means or by ambulance. In spite of the emergency beds forming only a fraction of the hospital beds, they consume a relatively large proportion of the hospitals resources. There is a requirement to ascertain the cost incurred in providing emergency care treatment to the patients coming to an apex tertiary care center, whose principal mandate is to provide tertiary care treatment. The study will not only help in allocating funds to the ED in an apex tertiary care facility but will also be useful if the hospital authorities decide to outsource the emergency services to a third party. Aims and objectives To study the cost incurred in providing emergency care services in an apex tertiary care hospital. To identify the various cost centers pertaining to patient care in the emergency care department and to estimate the cost of rendering patient care in ED and the cost of running the emergency per day. Materials and methods Six months’ retrospective data were collected from the ED, accounts section, engineering section, stores department, radiology department, emergency lab, computer facility, etc. The cost was apportioned to per patient as well per hour in rendering emergency care services. Observations The total cost incurred in providing emergency care services in the hospital under study was Rs 2034 per patient, while Rs 31,000 are spent per hour in running the emergency care facility. Discussion Almost 40 to 50% of the total cost incurred on providing emergency care services goes to the salary head of the staff working in the ED. The next major sources of expenditure are the radiology and lab investigations. Conclusion The study suggests that a considerable amount of hospital funds are spent on providing emergency care services in the apex tertiary care facility, whose primary mandate is to provide tertiary care services. The possibility of complete outsourcing or partial outsourcing in the form of radiology investigations and hiring humanpower on a contract basis can be a viable solution, to reduce the cost on providing emergency care, which can better be utilized in providing high-end tertiary care facilities. How to cite this article Garg N, Gupta SK, Lathwal A, Garg R. A Study of Cost incurred in providing Emergency Care Services in an Apex Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2016;4(1):45-50.

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

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

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.

scholarly journals Management Strategy of Patients Attending at Epilepsy Clinic in a Tertiary Care Hospital of Bangladesh

2020 ◽  
Vol 6 (1) ◽  
pp. 3-8
Author(s):  
Mohammad Sayeed Hassan ◽  
Md Shafikul Islam Khan ◽  
Paritosh Kumar Sarkar ◽  
Anwar Israil ◽  
Ferdous Ara ◽  
...  
Keyword(s):  
Partial Seizure ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Partial Epilepsy ◽  
Absence Seizure ◽  
Care Hospital ◽  
Cross Sectional ◽  
Tonic Seizure ◽  
Number Of Patients ◽  
Generalized Epilepsy

Background: Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. Objective: The aim of our study was to determine the types of epilepsies along with their treatment strategies among patients attending the outdoor epilepsy clinic in a referral tertiary care hospital. Methodology: This cross sectional study was carried out from the records of weekly epilepsy clinic of Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to August 2019. Data were collected through a predesigned questionnaire containing information about demography, clinical features, EEG and imaging findings and treatment of patients. Results: A total number of 1832 patients were recruited. There was a male (55.3%) and urban (61.1%) predominance. Most (75.1%) of the patients were young (age range from 10 to 29 years). A large number of patients were student (44.4%) and 24.2% were unemployed. The duration of epilepsy in most patients were less than 5 years (40.7%). 58.3% patients took various forms of indigenous treatment prior to attending this clinic. 54.7% patients had no comorbid illness. EEG was abnormal in 34.5% patients of which 24.4% had focal abnormality and 10.1% had generalized epileptic discharge. In brain imaging (CT/MRI) only 16.4% showed abnormal findings. 49.5% patients were suffering from generalized epilepsy whereas 44.6% had partial epilepsy. Among the generalized epilepsy group, most of them had generalized tonic clonic seizure (GTCS) (75.4%), while 8.9% had absence seizure and 7.9% had tonic seizure. In partial epilepsy group, the majority were secondary generalized seizure (74.7%), followed by complex partial seizure (CPS) (18.7%) and simple partial seizure (6.6%).42.7% patients got single antiepileptic drug whereas 37.4% patients received dual drug. Polytherapy (three or more drugs) were prescribed in 14% patients. Valproic acid was the highest prescribed drug (29.3%) either as monotherapy or in combination. Carbamazepine (27.4%) was the second common drug followed by Levetiracetam (15.1%). Conclusion: Epilepsy affects almost all groups of the society. Most of the patients remain seizure-free with judicious anti-epileptic drugs. Therefore, more effort is needed for early accurate diagnosis and appropriate treatment of epilepsy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 3-8

scholarly journals Clinical outcome of infants younger than two months in children ward of a tertiary care hospital, Nepal

2016 ◽  
Vol 3 (2) ◽  
pp. 15-18
Author(s):  
Ganesh Shah ◽  
Dinesh Dharel ◽  
Anish K Shah ◽  
Bikal Sapkota ◽  
Asmita Bhattarai
Keyword(s):  
Blood Culture ◽  
Clinical Outcome ◽  
Skin Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Facility ◽  
Clinical Profile ◽  
Care Hospital ◽  
Young Infants ◽  
Level Hospital

 Introductions: Newborn and young infants are most vulnerable for preventable deaths, particularly in developing countries. This study was conducted to see the clinical profile and outcome of infants less than two months of age admitted in children ward of Patan Hospital.Methods: This descriptive retrospective study was conducted at Patan Hospital, over 12 months from April 2014 to March 2015. Hospital records of all admitted infants aged less than two months were reviewed. The demographic characteristics, clinical profile and clinical outcome were descriptively analyzed.Results: Out of 2062 admissions in children ward, 614 (29.8%) were infants aged less than two months, out of which 482 were neonates less than 28 days. Among these neonates, 114 were inborn. Out of 436 infections, blood culture was positive in 37 (8.9%). There were 4 (0.04%) deaths, 4 (0.04%) referral and 22 (0.25%) left against medical advice. Infection 436 (436) was the commonest cause of illness, of which neonatal sepsis was 163 (37.4%), pneumonia 130 (30%) staphylococcal skin infection 39 (8.7%) and UTI 34 (7.8%). There were 71 (11.6%) cases of neonatal hyperbilirubinemia. Blood culture was positive in 55 (9%) with CONS being the commonest organism isolated; 19 (51.3%).Conclusions: Children ward contributes significantly to the care of sick infants less than two months of age, especially out born ones, requiring neonatal care facility in tertiary level hospital of Nepal. As most admissions are for infection, followed by hyperbilirubinemia, pediatrics wards need to be equipped and staffed accordingly to meet the need of sick young infants.Journal of Patan Academy of Health  Sciences. 2016 Dec;3(2):15-18

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