Level of Disaster Preparedness in Patients Visiting the Emergency Department: Results of the Civilian Assessment of Readiness for Disaster (CARD) Survey

AbstractBackgroundPatients seeking care in public hospitals are often resource-limited populations who have in past disasters become the most vulnerable. The objective of this study was to determine the personal disaster preparedness of emergency department (ED) patients and to identify predictors of low levels of preparedness. It was hypothesized that vulnerable populations would be better prepared for disasters.MethodsA prospective cross-sectional survey was conducted over a one-year period of patients seeking care in a public university hospital ED (census 65,000). Exclusion criteria were mentally impaired, institutionalized, or non-English speaking subjects. Subjects completed an anonymous survey detailing the 15 personal preparedness items from the Federal Emergency Management Agency's disaster preparedness checklist as well as demographic characteristics. Summary statistics were used to describe general preparedness. Chi-square tests were used to compare preparedness by demographics.ResultsDuring the study period, 857/1000 subjects completed the survey. Participants were predominantly male (57%), Caucasian (65%), middle-aged (mean 45 years), and high school graduates (83%). Seventeen percent (n = 146) reported having special needs and 8% were single parents. Most participants were not prepared: 451 (53%) had >75% of checklist items, 393 (46%) had food and water for 3 days, and 318 (37%) had food, water, and >75% of items. Level of preparedness was associated with age and parenting. Those aged 44 and older were more likely to be prepared for a disaster compared to younger respondents. (43.3% vs 31.1%, P = .0002). Similarly, single parents were more likely to be prepared than dual parenting households (47.1 vs 32.9%, P = .03).ConclusionsThis study and others have found that only the minority of any group is actually prepared for disaster. Future research should focus on ways to implement disaster preparedness education, specifically targeting vulnerable populations, then measuring the effects of educational programs to demonstrate that preparedness has increased as a result.TrueNA, AdedoyinJD, ShoferFS, HastyEK, BriceJH. Level of disaster preparedness in patients visiting the emergency department: results of the Civilian Assessment of Readiness for Disaster (CARD) survey. Prehosp Disaster Med.2013;28(2):1-5.

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Expectations and needs of relatives of critically ill patients in the emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918802737 ◽

2018 ◽

Vol 26 (6) ◽

pp. 328-335

Author(s):

Umut Ocak ◽

Levent Avsarogullari

Keyword(s):

Emergency Department ◽

Critically Ill ◽

Critically Ill Patients ◽

University Hospital ◽

Family Needs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Family ◽

Meaning Category

Background:The care of critically ill patients is a strong indicator of service quality provided in the emergency department. Since families are the major social support sources, assessing the family members’ needs may reduce their anxiety and depression owing to the acute situation of their loved ones while improving the patients’ recovery.Objective:We aimed to evaluate the expectations and needs of relatives of critically ill patients to formulate solutions to improve the quality of emergency department service.Methods:We conducted a prospective, cross-sectional survey of 873 relatives of nontraumatic, critically ill patients who completed the Turkish version of the Critical Care Family Needs Inventory in the emergency department of a university hospital in Turkey. The needs statements were evaluated under five subheadings: meaning, proximity, communication, comfort, and support.Results:In total, 249 (28.5%) participants were females and 624 (71.5%) were males (mean age, 41.79 years). The “meaning” category was given the highest priority, followed by “communication,” with average points of 3.75 and 3.57, respectively. The most important needs were being informed regularly about the patient’s condition and being assured that the patient is under the best possible care, whereas personal, physical, and emotional needs were the least important.Conclusion:Relatives of critically ill patients primarily focus on the quality of patients’ care. Creating a positive rapport based on trust and providing a healthcare environment where the expectations and needs of relatives are met should be prioritized by emergency department physicians, nurses, and other staff while caring for critically ill patients.

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Disaster preparedness among Thai elderly emergency department patients: A survey of patients’ perspective

10.21203/rs.2.10829/v1 ◽

2019 ◽

Author(s):

Jiraporn Sri ◽

Alissara Vanichkulbodee ◽

Natchapon Sinsuwan ◽

Rapeeporn Rojsaengroeng ◽

Anucha Kamsom ◽

...

Keyword(s):

Emergency Department ◽

Disaster Preparedness ◽

The Elderly ◽

Severe Trauma ◽

Future Research ◽

Cross Sectional ◽

Middle Income ◽

Institutional Review ◽

Comprehensive Plans ◽

Underlying Diseases

Abstract Background: In disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness. Methods: This study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaire’s (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Thai Institutional Review Board (IRB). Results: A total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66-81] years and the most common underlying diseases were hypertension [148 patients(60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients(72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients(56.8%)]. While 175/197 (81.8%) of patients who have underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency tool-box for disasters. Most 159 (65.4%) patients did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations. Conclusions: While most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

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Patient Opinion of Visiting Therapy Dogs in a Hospital Emergency Department

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082968 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2968

Author(s):

Joanne Reddekopp ◽

Colleen Anne Dell ◽

Betty Rohr ◽

Barbara Fornssler ◽

Maryellen Gibson ◽

...

Keyword(s):

Emergency Department ◽

University Hospital ◽

Therapy Dogs ◽

Hospital Emergency ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Therapy Dog ◽

Significant Difference ◽

Patient Opinion

To date there have been no studies examining whether patients want emergency department (ED) therapy dog programs. This patient-oriented study examined the opinions of patients about whether they would want to be visited by a therapy dog in the Royal University Hospital ED. Cross-sectional survey data were collected over a six week period from a convenience sample of 100 adult patients who had not been visited by a therapy dog in the ED. Most (80%) indicated they would want a visit by a therapy dog as an ED patient. A higher proportion of individuals who currently have a pet dog (95%) or identify as having lots of experience with dogs (71%) were more likely to indicate this want compared to those without a dog (90%) or little to no experience with dogs (62%). The majority were also of the opinion that patients may want to visit a therapy dog in the ED to reduce anxiety (92%) and frustration (87%) as well as to increase comfort (90%) and satisfaction (90%) and to a lesser extent to reduce pain (59%). There was no significant difference in findings by gender or age, other than a higher proportion of older adults and females identifying cultural background and tradition as a possible reason that patients may not want to be visited by a therapy dog. The findings of this study can help guide considerations for future ED therapy dog programs.

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Disaster preparedness among Thai elderly emergency department patients: a survey of patients’ perspective

BMC Emergency Medicine ◽

10.1186/s12873-019-0269-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jiraporn Sri-on ◽

Alissara Vanichkulbodee ◽

Natchapon Sinsuwan ◽

Rapeeporn Rojsaengroeng ◽

Anucha Kamsom ◽

...

Keyword(s):

Emergency Department ◽

Disaster Preparedness ◽

The Elderly ◽

Severe Trauma ◽

Future Research ◽

Cross Sectional ◽

Middle Income ◽

Institutional Review ◽

Comprehensive Plans ◽

Underlying Diseases

Abstract Background In disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness. Methods This study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB). Results A total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66–81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations. Conclusions While most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

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Disaster preparedness among Thai elderly emergency department patients: A survey of patients’ perspective

10.21203/rs.2.10829/v3 ◽

2019 ◽

Author(s):

Jiraporn Sri ◽

Alissara Vanichkulbodee ◽

Natchapon Sinsuwan ◽

Rapeeporn Rojsaengroeng ◽

Anucha Kamsom ◽

...

Keyword(s):

Emergency Department ◽

Disaster Preparedness ◽

The Elderly ◽

Severe Trauma ◽

Future Research ◽

Cross Sectional ◽

Middle Income ◽

Institutional Review ◽

Comprehensive Plans ◽

Underlying Diseases

Abstract Background: In disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness. Methods: This study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB). Results: A total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66-81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations. Conclusions: While most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

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Disaster preparedness among Thai elderly emergency department patients: A survey of patients’ perspective

10.21203/rs.2.10829/v2 ◽

2019 ◽

Author(s):

Jiraporn Sri ◽

Alissara Vanichkulbodee ◽

Natchapon Sinsuwan ◽

Rapeeporn Rojsaengroeng ◽

Anucha Kamsom ◽

...

Keyword(s):

Emergency Department ◽

Disaster Preparedness ◽

The Elderly ◽

Severe Trauma ◽

Future Research ◽

Cross Sectional ◽

Middle Income ◽

Institutional Review ◽

Comprehensive Plans ◽

Underlying Diseases

Abstract Background: In disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness. Methods: This study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB). Results: A total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66-81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations. Conclusions: While most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

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LO067: Emergency department management of diabetic ketoacidosis and hyperosmolar hyperglycemic state: national survey of attitudes and practice

CJEM ◽

10.1017/cem.2016.104 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S53-S53

Author(s):

A. Hamelin ◽

J. Yan ◽

I.G. Stiell

Keyword(s):

Emergency Department ◽

Diabetic Ketoacidosis ◽

Diabetes Education ◽

Guideline Implementation ◽

Physician Attitudes ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Canadian Association ◽

Hyperosmolar Hyperglycemic State

Introduction: The 2011 Canadian Diabetes Association (CDA) Clinical Practice Guidelines were developed in order to help physicians manage hyperglycemic emergencies in the emergency department (ED), including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The goal of this study was to determine physician attitudes towards these guidelines and to identify potential barriers to their implementation in the ED. Methods: We distributed an online, cross sectional survey to 500 randomly selected members of the Canadian Association of Emergency Physicians (CAEP) who were currently practicing physicians. A total of 3 email notifications were distributed on days 1, 7 and 14. The survey consisted of 23 questions relating to physician management of DKA and HHS in the ED. The primary outcome was overall physician familiarity and usage of the guidelines using a 7-point Likert scale. Secondary outcomes included physician attitudes towards the guidelines as well as any perceived barriers to their implementation in the ED. Simple descriptive statistics were used to illustrate the survey results. Results: The survey response rate was 62.2% (311/500) with the following participant characteristics: male (62.6%), CCFP(EM) training (46.1%) and working in major academic centers (50.5%). The overall awareness rate of the CDA guidelines was 22.9% (95% CI = 18.3%, 27.5%). 58.9% (95% CI = 53.3%, 64.3%) reported the CDA guidelines being useful. The most frequently reported barriers to CDA guideline implementation were concerns about education issues (56.0%), lack of time and disruption of flow (23.9%), staffing and human resource issues (26.7%) and poor policy adherence (25.5%). Physician’s ideal changes to optimize the management of these patients included improved coordination for follow-up with family physicians (79.9%), increased diabetes education for patients (73.9%) and increased availability to diabetes specialists (47.5%). Conclusion: In this study, although Canadian ED physicians were generally supportive of the CDA guidelines, many were unaware that these guidelines existed and barriers to their implementation were reported. Future research should focus on strategies to standardize DKA and HHS management by ensuring physician awareness and education to ensure the highest quality of patient care.

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Prevalence, risk factors and sources of anxiety among Emergency Department healthcare workers in Pakistan during COVID-19 pandemic: A single center survey

Experimental Results ◽

10.1017/exp.2020.68 ◽

2021 ◽

Vol 2 ◽

Author(s):

N. Haroon ◽

S. S. Owais ◽

A. S. Khan ◽

J. Amin

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Health Care Providers ◽

Healthcare Workers ◽

Work Performance ◽

Nonparametric Tests ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Frontline Workers

Summary COVID-19 has challenged the mental health of healthcare workers confronting it world-wide. Our study identifies the prevalence and risk of anxiety among emergency healthcare workers confronting COVID-19 in Pakistan. We conducted a cross-sectional survey in an Emergency Department using the Generalized Anxiety Scale (GAD-7), and questions about sources of anxiety. Of 107 participants, 61.7% were frontline workers. The prevalence of anxiety was 50.5%. Nonparametric tests determined that nurses, younger and inexperienced staff, developed significant anxiety. Multivariate ordinal regression determined independent risk factors for developing anxiety were younger age (OR 2.11, 95% CI 0.89–4.99) and frontline placement (OR 1.34, 95% CI 0.33–1.66). Significant sources of stress were fear of infecting family (P = 0.003), lack of social support when the health care providers were themselves unwell (P = 0.02) and feelings of inadequate work performance (P = 0.05). Our study finds that HCWs’ anxiety is considerable. Appropriate measures for its alleviation and prevention are required.

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Discharge against medical advice from the emergency department in a university hospital

BMC Emergency Medicine ◽

10.1186/s12873-021-00422-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feras H. Abuzeyad ◽

Moonis Farooq ◽

Salah Farhat Alam ◽

Mudhaffar Ismael Ibrahim ◽

Luma Bashmi ◽

...

Keyword(s):

Emergency Department ◽

Cross Sectional Study ◽

Small Sample ◽

Medical Advice ◽

University Hospital ◽

High Risk Population ◽

Cross Sectional ◽

Against Medical Advice ◽

Level 3 ◽

Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

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The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

Canadian Journal of Nursing Research ◽

10.1177/08445621211014421 ◽

2021 ◽

pp. 084456212110144

Author(s):

Behdin Nowrouzi-Kia ◽

Mary T. Fox ◽

Souraya Sidani ◽

Sherry Dahlke ◽

Deborah Tregunno

Keyword(s):

Emergency Department ◽

Role Conflict ◽

Acute Care ◽

Acute Care Hospitals ◽

Cross Sectional Survey ◽

Eligibility Criteria ◽

Cross Sectional ◽

Medical Unit ◽

Scale Scores ◽

Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

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