Screening for alcohol problems in emergency department patients with minor injury: results and recommendations for practice and policy

In order to assess the feasibility of emergency department (ED) physician screening of patients with minor injuries for alcohol problems, a two-part screening process was implemented in an urban ED. Blood alcohol concentration was measured using either a saliva strip or a serum alcohol test. Questions about alcohol use frequency, and consumption quantity were asked in addition to the CAGE questions. Over a one-year period 2,439 adults (age ≥ 18 years) with non-life-threatening injuries were screened. Multiple strategies were used in order to increase compliance over the course of the study. Over the first six months, the overall screening rate increased from 8% to 45% and remained level for most of the duration of the project. Individual variations in rates ranged from 5% to 70%. Screening for alcohol problems is feasible in the ED setting and may be integrated as part of the role of the ED physician.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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The characteristics associated with alcohol co-ingestion in patients visited to the emergency department with deliberate self-poisoning: retrospective study

10.22514/sv.2021.035 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Odds Ratio ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Self Report ◽

C Reactive Protein ◽

Alcohol Group ◽

Reactive Protein ◽

History Of

Objective: The aim of this study was to investigate the characteristics associated with alcohol co-ingestion by measuring blood alcohol concentration in patients visited to the emergency department with deliberate self-poisoning. Also, it was to evaluate the accuracy of self-reported alcohol ingestion. Methods: The initial assessment forms, medical records and laboratory tests of patients visited to the ED after DSP between March 2017 and June 2020 were retrospectively reviewed. Based on the patients’ BAC, two groups were formed: the non-alcohol group and the alcohol group. Results: This study included 286 patients (56.6%, n = 162) in the non-alcohol group and 43.4% (n = 124) in the alcohol group. In multivariate logistic analysis, alcohol co-ingestion was independently associated with no history of psychiatric admission (Odds Ratio = 6.222, 95% Confidence Interval = 1.148-33.716, P = 0.034), lactate (mg/dL)(Odds Ratio = 1.961, 95% Confidence Interval = 1.274-3.019, P = 0.002), and C-reactive protein level (mg/dL) (Odds Ratio = 0.003, 95% Confidence Interval = 0.000-0.897, P = 0.046). The receiver operating characteristics analysis of lactate value for the association with alcohol co-ingestion showed a cutoff value of 1.45, with 88.1% sensitivity, 71.6%specificity, and an area under the curve of 0.845. There was no statistically significant difference in emergency department disposition between the two groups. Using the 261 subjects who completed the self-report of alcohol co-ingestion, self-report resulted in 77.6% sensitivity and 76.6% specificity for the assessment of alcohol co-ingestion. The positive and negative predictive values for self-reporting were 72.6% and 81.0%, respectively. Conclusions: Alcohol co-ingestion was associated with no history of psychiatric ward admission, high lactate levels, and low C-reactive protein values in patients who visited the emergency department with deliberate self-poisoning. This study showed that self-reported alcohol co-ingestion was not a substitute for the blood alcohol concentration test.

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Diversity for diversity: A “fast track” nursing service model to complement conventional emergency medicine service in a busy urban area emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920931709 ◽

2020 ◽

pp. 102490792093170

Author(s):

Ng Hing Yin ◽

Fan Kin Ping ◽

Lo Chor Man

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Fast Track ◽

Waiting Times ◽

Clinical Protocols ◽

Service Model ◽

Nursing Service ◽

Life Threatening ◽

Emergency Department Patients ◽

High Level

Background: In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes. Objectives: This article reports the service outcomes of the Fast Track Nursing Service. Methods: Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service. Results: This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service. Conclusion: Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.

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Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country

BMC Infectious Diseases ◽

10.1186/s12879-019-4301-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Maythita Ittisanyakorn ◽

Sukkhum Ruchichanantakul ◽

Alissara Vanichkulbodee ◽

Jiraporn Sri-on

Keyword(s):

Emergency Department ◽

Infectious Diseases ◽

Middle Income Country ◽

Income Country ◽

Middle Income ◽

Factors Associated ◽

Emergency Department Patients ◽

One Year

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The Blood Alcohol Concentration Testing Emergency Room Investigation Analysis Study: A 1-Year Review of Blood Alcohol Concentration Testing in an Emergency Department

Advances in Emergency Medicine ◽

10.1155/2015/410827 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Ayman Elgammal ◽

Doireann Eves ◽

Abbas Albaghli ◽

Daniel Kane ◽

Robert Durcan ◽

...

Keyword(s):

Emergency Department ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

Descriptive Statistics ◽

Blood Alcohol ◽

Analysis Model ◽

Multifactorial Analysis ◽

Analysis Study ◽

Clinical Scenarios ◽

Actual Use

Aim. To describe the actual use of blood alcohol concentration (BAC) testing in an emergency department. Method. This study was performed to examine in what circumstances emergency medicine doctors and nurses request blood alcohol concentrations and the outcome of patients so tested. A retrospective study was performed. A database of all the patients who presented to the emergency department and who were tested for BAC in 2012 was created. Descriptive statistics are used to present the findings. Results. During 2012, there were 1191 patients on whom BAC testing was performed. 37 patients had a BAC greater than the allegedly lethal concentration of 400 mg/100 mL. Using a multifactorial analysis model, a higher blood alcohol concentration was associated with a lower Glasgow Coma Score. Conclusion. BAC testing is most often performed in the context of alleged overdose. BAC was performed in other clinical scenarios albeit in less than 2% of all ED attendances.

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