PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine

2021 ◽  
Vol 38 (9) ◽  
pp. A16.3-A17
Author(s):  
David Fish ◽  
Fiona Bell ◽  
Clare O’Connell ◽  
Alison Walker ◽  
Laura Evans ◽  
...  
Keyword(s):  
Emergency Department ◽  
Descriptive Analysis ◽  
Hospital Setting ◽  
Ambulance Service ◽  
Trauma Centres ◽  
Administration Routes ◽  
Controlled Drugs ◽  
Medical Directors ◽  
Legislative Changes ◽  
The Impact

BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.

scholarly journals A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

2021 ◽  
Author(s):  
Mei Qiu Lim ◽  
Fahad Javaid Siddiqui ◽  
Seyed Ehsan Saffari ◽  
Andrew Fu Wah Ho ◽  
Johannes Nathaniel Min Hui Liew ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Disease ◽  
Descriptive Analysis ◽  
Circuit Breaker ◽  
Historical Period ◽  
Management Planning ◽  
Crowd Management ◽  
Patient Demographics ◽  
Icd 10 ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

scholarly journals OHS Disclosures Within Non-Financial Reports: The Romanian Case

2020 ◽  
Vol 12 (5) ◽  
pp. 1963
Author(s):  
Ana Petrina Păun ◽  
Codruța Cornelia Dura ◽  
Sorin Mihăilescu ◽  
Roland Iosif Moraru ◽  
Claudia Adriana Isac
Keyword(s):  
Financial Reporting ◽  
Descriptive Analysis ◽  
Health And Safety ◽  
Financial Reports ◽  
Regional Context ◽  
Eu Directive ◽  
Sustainability Reports ◽  
Legislative Changes ◽  
Local Companies ◽  
The Impact

The article addresses the issue of disclosing Occupational Health and Safety (OHS) issues by corporations in Romania, under the influence of recent changes in the legislative framework imposed by the adoption of the EU Directive 2014/95/EU on non-financial reporting by large corporations exceeding 500 employees. The goal of our study consist in determining the relevant factors that influence the level of the Romanian companies’ OHS disclosure. To this end, we have compiled a sample of 35 organizations that have elaborated and published non-financial reports during 2016–2017 and we have analysed the impact of some relevant determinants upon the reporting phenomenon. With the aim of providing a clear picture of the regional context of our study, we put together many pieces of information regarding the corporations that played the trend-setters role in Romania, by disclosing corporate social responsibility (CSR)/sustainability reports between 2003 and 2017, although this practice has been characterized by a voluntary and unsteady approach in many cases. The importance of outlining the regional context of the Romanian reporting companies is given by the urge to raise the local managers’ level of awareness towards sustainability issues and to use the recent legislative changes as opportunities to catch up with more advanced EU countries. The research methods used in order to identify the interdependencies established between the key factors involved in the disclosure practices included a mixed quantitative-qualitative approach, and referred to: content analysis of sustainability reports; descriptive analysis of the statistical variables which were taken into consideration; correlation analysis of numerical variables; and the ANOVA method for investigating the interdependencies between the categorical and numerical variables. Among the influencing factors that impact with a greater or lesser intensity the quality of OHS reporting performed by the local companies, the following were highlighted: the corporations’ market share, their field of activity, and the ownership structure.

Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 468-472 ◽  
Author(s):  
Etimbuk Umana ◽  
Josephine Hannah Kelliher ◽  
Christiaan Johannes Blom ◽  
Brian McNicholl
Keyword(s):  
Emergency Department ◽  
Shoulder Dislocation ◽  
Recovery Time ◽  
Patient Flow ◽  
Hospital Setting ◽  
Anterior Shoulder Dislocation ◽  
Fracture Dislocations ◽  
Record Review ◽  
The Impact ◽  
Successful Reduction

ABSTRACTObjectivesMethoxyflurane is an inhalation analgesic used in the emergency department (ED) but also has minimal sedative properties. The major aim of this study was to evaluate the success rate of methoxyflurane for acute anterior shoulder dislocation (ASD) reduction. The secondary aim was to assess the impact of methoxyflurane on ED patient flow compared to propofol.MethodsA health record review was performed for all patients presenting with ASD who underwent reduction with either methoxyflurane or propofol over a 13-month period (December 2016 – December 2017). The primary outcome was reduction success for methoxyflurane, while secondary outcomes such as recovery time and ED length of stay (LOS) were also assessed compared to propofol. Patients with fracture dislocations, polytrauma, intravenous, or intramuscular opioids in the pre-hospital setting, no sedation for reduction, and alternative techniques of sedation or analgesia for reduction were excluded.ResultsA total of 151 patients presented with ASD during the study period. Eighty-two patients fulfilled our inclusion criteria. Fifty-two patients had ASD reduction with propofol while 30 patients had methoxyflurane. Successful reduction was achieved in 80% (95% CI 65.69% to 94.31%) patients who used methoxyflurane. The median recovery time and ED LOS were 30 minutes [19.3-44] and 70.5 minutes [49.3-105], which was found to be shorter for the methoxyflurane group, who had successful reductions compared to sedation with propofol.ConclusionMethoxyflurane was used successfully in 30% of the 82 patients undergoing reduction for ASD, while potentially improving ED efficiency.

The Impact of Relocating Vasectomies from Hospital Outpatient Departments to Non-Hospital Sites

1995 ◽  
Vol 8 (1) ◽  
pp. 46-51
Author(s):  
Wendy Young ◽  
Vivek Goel
Keyword(s):  
Descriptive Analysis ◽  
Age Distribution ◽  
Hospital Setting ◽  
Insurance Plan ◽  
Ontario Health Insurance Plan ◽  
Funding Policies ◽  
Outpatient Departments ◽  
Hospital Resources ◽  
The Impact ◽  
Hospital Outpatients

The objective of this study was to estimate the net dollar value of hospital resources that would be released if vasectomies currently performed in outpatient departments were performed in non-hospital sites. This article provides a descriptive analysis using administrative data for all non-hospital sites and all acute care institutions in Ontario performing vasectomies. It is based on 23,741 records of patients for whom a vasectomy was billed to the Ontario Health Insurance Plan (OHIP) in 1991–92. No substantial differences in the age distribution of patients were seen in non-hospital sites and those in hospital settings. About 75% of hospital outpatients received a local anesthetic that could have been administered in a non-hospital setting. Approximately $4.4 million in hospital resources would be released if 75% of all outpatient vasectomies were performed in non-hospital settings while OHIP billings would increase only by about $140,000. The demands on hospital funds available for patient activity could have been decreased by about $6.2 million, if this shift had occurred in 1991–92. Although opportunities exist in Ontario to release hospital resources by shifting vasectomies to non-hospital sites, current hospital and physician funding policies may represent a disincentive to shift activity away from institutional-based care.

scholarly journals The impact of the Covid-19 pandemic on the short and mid-term urological emergencies and the emergency department

2021 ◽  
Vol 38 (4) ◽  
pp. 466-470
Author(s):  
Hülya Yılmaz BAŞER ◽  
Aykut BAŞER
Keyword(s):  
Emergency Department ◽  
Health Care Services ◽  
Descriptive Analysis ◽  
Relevant Information ◽  
Medium Term ◽  
Dynamic Changes ◽  
Care Services ◽  
The Impact ◽  
Urological Emergencies

Dynamic changes are observed in the delivery of health care services due to the COVID-19 Pandemic. Its effect in the short term is a dramatic decrease in service, however, its effect in the medium and long term is unknown. In this study, we aimed to investigate the effects of the COVID-19 pandemic on emergency department and emergency urological surgery in the short and medium term during the 8-month period, and the reasons for possible changes. Emergency department operations, urology operations and emergency surgical procedures between April and November were compared as the 2020 pandemic period and the 2019 non-pandemic period. The relevant information was obtained from the hospital management information system. Descriptive analysis and statistical methods comparing the two periods were used. In the early stages of the pandemic, significant decreases were observed in both urology procedures and emergency department operations. In the medium period, while emergency department operations and urology consultations returned to the non-pandemic periods, there was no such a change in in emergency urological surgeries. In the medium-term effects of the pandemic, emergency department operations returned to the non-pandemic periods due to reasons such as patients' abuse of emergency departments in line with their requests for rapid diagnosis and treatment. In accordance with the changing nature of the pandemic, it is necessary to make different scheduling for emergency department operations and emergency surgeries.

scholarly journals First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Marios Charalambous ◽  
Holger A. Volk ◽  
Luc Van Ham ◽  
Sofie F. M. Bhatti
Keyword(s):  
Status Epilepticus ◽  
Drug Administration ◽  
Hospital Setting ◽  
First Line ◽  
Onset Of Action ◽  
Systemic Complications ◽  
Administration Routes ◽  
The Impact ◽  
Line Management ◽  
At Home

AbstractStatus epilepticus (SE) or prolonged epileptic seizure activity is a common neurological emergency with a high mortality rate and, if left untreated, can lead to irreversible cerebral damage and systemic complications. Fast and effective first-line management is of paramount importance, particularly in the at-home management of seizures where drug administration routes are limited. Benzodiazepines (BZDs) have been exclusively used in veterinary medicine for decades as first-line drugs based on their high potency and rapid onset of action. Various administration routes exist in dogs, such as oral, intravenous, intramuscular, rectal, and intranasal, all with different advantages and limitations. Recently, intranasal drug delivery has become more popular due to its unique and favourable characteristics, providing potential advantages over other routes of drug administration in the management of canine SE. This narrative review provides an outline of the management of SE at home and in a hospital setting, discusses considerations and challenges of the various routes of BZD administration, and evaluates the impact of intranasal drug administration (nose-brain pathway) for controlling canine SE at home and within hospital settings.

THE JAM IN THE SANDWICH, DOWN HERE IN A&E': STAFF PERSPECTIVES ON THE IMPACT AND CAUSES OF HANDOVER DELAYS BETWEEN THE AMBULANCE SERVICE AND THE EMERGENCY DEPARTMENT

2015 ◽  
Vol 32 (6) ◽  
pp. e16.3-e17
Author(s):  
Alison Porter ◽  
Bridie Angela Evans ◽  
Becky Gammon ◽  
Robert Harris Mayes ◽  
Mark Poulden ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ambulance Service ◽  
The Impact

scholarly journals Use of the Emergency Ambulance Service to an Inner City Accident and Emergency Department – a Comparison of General Practitioner and ‘999’ Calls

1991 ◽  
Vol 84 (12) ◽  
pp. 726-727 ◽  
Author(s):  
A G Pennycook ◽  
R M Makower ◽  
W G Morrison
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Hospital Setting ◽  
Ambulance Service ◽  
Inappropriate Use ◽  
Accident And Emergency ◽  
Emergency Ambulance ◽  
Accident And Emergency Department ◽  
A Prospective Study ◽  
Effective Use

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a ‘999’ call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.

scholarly journals Impact of pharmacist discharge counseling on hospital readmission and emergency department visit

2017 ◽  
Vol 6 (2) ◽  
pp. 68 ◽  
Author(s):  
Tu Tran ◽  
Saijal Khattar ◽  
Tiffany T. Vu ◽  
Maggie Potter ◽  
Jane Hodding ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Readmission ◽  
Community Hospital ◽  
Descriptive Analysis ◽  
Hospital Readmissions ◽  
Outpatient Setting ◽  
Transitions Of Care ◽  
Study Objective ◽  
Entire Cohort ◽  
The Impact

Objective: The enactment of the Affordable Care Act (ACA) in 2010 imposes payment penalty on hospitals with high hospital readmission rates. In an effort to reduce readmissions, a pharmacist discharge counseling program was implemented to facilitate transition of care to the outpatient setting. Our study objective was to evaluate the impact of the program on hospital readmissions and visits to the emergency department (ED).Methods: This was a single-center, retrospective cohort study conducted at a not-for-profit, teaching community hospital with 462 total beds. Pharmacists provided counseling to patients discharged from the medicine floor between November 2013 and January 2014, and included those considered to be high-risk (e.g., taking 5 scheduled medications and had diseases such as congestive heart failure and diabetes mellitus). Descriptive analysis was performed and outcomes were compared between patients who did and did not receive pharmacist counseling.Results: Of a total of 889 discharged patients, 488 (55%) received counseling from a pharmacist. For the entire cohort, mean age was 55 ± 20 years; Charlson Comorbidity Index (CCI) score was 2.74 ± 2.95; and length of hospitalization was 4 ± 4 days. These parameters were not statistically different between the two groups. Within 30-days after hospital discharge, significantly fewer subjects who received counseling, compared with those who did not, were readmitted to the hospital (11.3% vs. 15%, p = .009) or visited the ED (10.6% vs. 15%, p = .005).Conclusions: Discharge counseling provided by pharmacists during transitions of care at a community hospital significantly reduced 30-day readmission and ED visit rates.

scholarly journals LO54: A descriptive analysis of ED length of stay of admitted patients ‘boarded’ in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S46
Author(s):  
L. Salehi ◽  
P. Phalpher ◽  
R. Valani
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Descriptive Analysis ◽  
High Volume ◽  
Increased Risk ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Day Of The Week ◽  
The Mean ◽  
The Impact

Introduction: Previous studies have shown a link between Emergency Department (ED) overcrowding and worse clinical outcomes, increased risk of in-hospital mortality, higher costs, and longer times to treatment. Prolonged ED Length of Stay (LoS) of admitted patients awaiting a bed on in-patient units has been identified as a major driver of ED overcrowding. The purpose of this study is to provide a descriptive analysis of ED LoS among admitted patients, and determine the impact of prolonged ED LoS on total hospital in-patient length of stay (IP LoS). Methods: We conducted a single-site retrospective study for the period between January 1-December 31, 2015 at a very high volume community hospital. All patients aged ≥18 years admitted from the ED to acute in-patient Medicine units were identified. We carried out overall descriptive analysis (including analysis of day-of-the-week variability) on ED LoS. The mean total IP LoS for those patients with ED LoS<12 hours, 12-24 hours, and ≥24 hours were calculated and analyzed using ANOVA and Tukey HSD tests. Results: A total of 6,961 individuals were admitted to the medical units over the 12-month period. The median and mean ED LoS for admitted patients were 22.9 hrs (IQR: 13.9 hrs- 33.1 hrs) and 25.6 hrs respectively. Using ANOVA, there was a statistically significant difference in means of ED LoS as a function of the day of the week (p<0.0001), with Mondays having the highest mean ED LoS (27.6 hrs), and Fridays having the lowest (23.1 hrs). The mean IP LoS for those with ED LoS<12 hours, 12-24 hours, and ≥24 hours, were 6.8 days, 6.9 days, and 8.5 days respectively, with a statistically significant difference between group means (p<0.0001). Multiple pairwise comparisons of group means showed a statistically significant (p<0.05) difference between mean IP LOS of those with an EDLOS≥24 hours and those with an EDLOS<24 hours. Conclusion: Preliminary results indicate that ED LoS≥24 hours among admitted patients was associated with an increase in total IP LoS.*In the next 1-2 months, we intend to explore the role of other independent variables (age, sex, comorbidity, isolation status, and telemetry) on total ED LoS, and its association with IP LoS.

Sign in / Sign up

Export Citation Format

Share Document