scholarly journals Triage in emergency psychiatry

2000 ◽  
Vol 24 (7) ◽  
pp. 261-264 ◽  
Author(s):  
Audrey Morrison ◽  
Alastair Hull ◽  
Beryl Shepherd
Keyword(s):  
Response Assessment ◽  
Emergency Psychiatry ◽  
Clinical Implications ◽  
Telephone Triage ◽  
Triage System ◽  
Psychiatric Emergencies ◽  
Admission Rates ◽  
Speed Of Response ◽  
System Information ◽  
The Impact

Aims & MethodPsychiatric emergencies constitute a large proportion of psychiatric referrals, with the response to this need therefore of great importance. The impact of the introduction of a telephone triage system on such factors as speed of response, assessment site, outcome and the personnel performing the assessment is examined within the context of closing of a 24-hour open access emergency system. Information was gathered from all emergency referrals, with 80 subjects randomly chosen and studied in depth.ResultsThe triage system afforded a greater flexibility of response, and the involvement of more experienced clinicians. It did not reduce the overall referral or admission rates.Clinical ImplicationsTriage was found to be an effective method of introducing flexibility of response to emergency referrals while encouraging continuity of patient care.

scholarly journals Joint assessment out of hours: assessing the benefits for patients and junior doctors

2013 ◽  
Vol 37 (8) ◽  
pp. 272-275
Author(s):  
Laura Boyd ◽  
Colin Crawford ◽  
Eugene Wong
Keyword(s):  
Mental Health ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Assessment Protocol ◽  
Admission Rates ◽  
Mental Health Nurse ◽  
Health Nurse ◽  
The Impact ◽  
Joint Assessment

Aims and methodWe examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.ResultsIn the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.Clinical implicationsJoint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

scholarly journals The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

2021 ◽  
Vol 13 (4) ◽  
pp. 395-398
Author(s):  
J.E. Gaughran ◽  
D.M. Geddes-Barton ◽  
T Cliff ◽  
F Bailey ◽  
C Ovadia ◽  
...  
Keyword(s):  
Complication Rates ◽  
Telephone Triage ◽  
Management Options ◽  
Triage System ◽  
Patient Demographics ◽  
Significant Difference ◽  
Diagnosis Rate ◽  
Ectopic Pregnancies ◽  
Operative Findings ◽  
The Impact

Background: In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. Objective: To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. Materials and Methods: A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre-pandemic). Main outcome measures: Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. Results: There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. Conclusion: This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. What is new: Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

scholarly journals Droperidol dropped; consultants not consulted

2003 ◽  
Vol 27 (08) ◽  
pp. 301-304
Author(s):  
Gavin Reid ◽  
Mark Hughson
Keyword(s):  
Questionnaire Survey ◽  
Clinical Care ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
The West ◽  
Abrupt Withdrawal ◽  
Before And After ◽  
Adequate Evaluation ◽  
Psychiatric Profession ◽  
The Impact

Aims and Method We conducted a postal questionnaire survey of the practice of rapid tranquillisation among 215 consultant psychiatrists in the West of Scotland, before and after the withdrawal of droperidol by the manufacturer. Results One hundred and eighty questionnaires (84% of those sent) were returned. Droperidol had been used extensively, often combined with lorazepam, for rapid tranquillisation. The main replacement suggested for droperidol was haloperidol. About half of the respondents to our survey chose to comment on the withdrawal of droperidol. More than half of the comments were unfavourable, including lack of an adequate replacement and lack of consultation with the psychiatric profession. Clinical Implications The abrupt withdrawal of droperidol, partly for commercial reasons, was regrettable. There was no time for an adequate evaluation of possible replacement medications and a lack of consultation with the profession regarding the impact on clinical care.

scholarly journals An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system

2016 ◽  
Vol 24 (12) ◽  
pp. 5041-5048 ◽  
Author(s):  
Lorraine Warrington ◽  
Patricia Holch ◽  
Lucille Kenyon ◽  
Ceri Hector ◽  
Krystina Kozlowska ◽  
...  
Keyword(s):  
Patient Experiences ◽  
Telephone Triage ◽  
Triage System

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.

Abstract P116: VARIATION IN MEAN ARTERIAL PRESSURE (MAP) AND ITS HEMODYNAMIC COMPONENTS DURING 24-HOUR AMBULATORY PULSE WAVE ANALYSIS: IMPACT OF AGE, RACE, GENDER AND BODY SIZE

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Sagar Nagpal ◽  
Debduti Mukhopadhyay ◽  
Peter Osmond ◽  
Joseph E Schwartz ◽  
Joseph L Izzo
Keyword(s):  
Heart Rate ◽  
Pulse Wave ◽  
Beta Blockers ◽  
Demographic Characteristics ◽  
Pulse Wave Analysis ◽  
Clinical Implications ◽  
Wave Analysis ◽  
Contributing Factors ◽  
Clinical Associations ◽  
The Impact

BP is highly variable within and between individuals but the impact of variation in underlying hemodynamic components is unknown. We tested the feasibility and clinical associations of quantitated variances in MAP and its hemodynamic components [heart rate (HR), stroke volume (SV) and total vascular resistance (TVR)] obtained by 24-hr ambulatory pulse wave analysis (PWA, Mobil-O-Graph, IEM, Stolzberg, DE). BP and PWA were measured every 20 min for 24 hrs. Indexed to body surface area, MAP = HR*[SV index (SVI)]*[TVR index (TVRI)]; ln(MAP) = ln(HR) + ln(SVI) + ln(TVRI); and total MAP variability = var [ln(MAP)] = covariance (cov)[ln(HR), ln(MAP)] + cov[ln(SVI), ln(MAP)] + cov[ln(TVRI), ln(MAP)]. Relative contributions to var[ln(MAP)] for each hemodynamic component (as %) were calculated and associations with demographic characteristics were analyzed by correlations and t-tests. We studied 152 people (49% women, 23% black); mean(SD): # readings 57(11), age 59(16) yr, BMI 29.9(6.5) kg/m 2 , systolic BP 135(18) and MAP 106(14) mmHg. Mean(SD) 24-hr values were: ln(MAP) 4.64 (0.13), ln(HR) 4.20 (0.15), ln(SVI) -3.32 (0.15), and ln(TVRI) 3.75 (0.18). Relative contributions of hemodynamic components to total 24-hr ln(MAP) variation were: TVRI 54(36)%, HR 33(38)%, and SVI 13(40)%. The large SDs of these relative contributions led to analysis of potential contributing factors: TVRI contribution was correlated with 24-hr mean MAP (r=0.24, p=0.003) and was higher (>54%) in males (p=0.03) and blacks (p=0.04); HR contribution was inversely related to MAP (r=-0.26, p=0.001), age (r=-0.29, p=0.0003) and BMI (r=-0.173 p=0.05) and was lower (<33%) in blacks (p=0.008); SVI contribution was correlated with age (r=0.31, p<0.0001) and BMI (r=0.23, p=0.005) and was higher (>13%) in women (p=0.03). We conclude that 24-hr ambulatory PWA can identify components of MAP variation within individuals and their associations with demographic factors. The relative contributions of hemodynamic components (HR, SV, TVR) to 24-hr variability in ln(MAP) varies systematically with 24-hr mean MAP, age, race, gender, and BMI. Theoretical clinical implications may include therapeutic adjustments for extremes of variation in HR (beta-blockers), TVR (vasodilators) or SV (diuretics).

Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamshed Ali ◽  
Osman Faheem ◽  
Pirbhat Shams ◽  
ghufran adnan ◽  
Maria Khan
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Electronic Record ◽  
Medical Attention ◽  
Care Hospital ◽  
Record System ◽  
Admission Rates ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

THE IMPACT OF THE ROCHESTER NEIGHBORHOOD HEALTH CENTER ON HOSPITALIZATION OF CHILDREN, 1968 TO 1970

PEDIATRICS ◽  
1973 ◽  
Vol 51 (5) ◽  
pp. 833-839
Author(s):  
Michael Klein ◽  
Klaus Roghmann ◽  
Kenneth Woodward ◽  
Evan Charney
Keyword(s):  
Health Center ◽  
Comparison Group ◽  
Admission Rate ◽  
Team Approach ◽  
Target Area ◽  
Admission Rates ◽  
Respiratory Infectious Diseases ◽  
Physician Availability ◽  
Hospital Days ◽  
The Impact

The admission patterns of children to area hospitals was studied. The study design allowed for comparisons between actual users of the health center, nonusers who lived in the target area and a comparison group. During the second year of operation, the admission rate of health center users was only 33 versus 67 per thousand for nonusers and 39 per thousand for the comparison group. Comparing the first two years, hospital days per thousand among users dropped by approximately half. Due to higher admission rates and longer average stays, nonusers had a rate of 2.5 times that of the users for hospital days per thousand. The rate for the comparison group remained constant. Users had fewer admissions for respiratory infectious diseases and more admissions for surgical restorative procedures. These trends were not present for the nonusers or for the comparison group. Despite extensive outreach, physician availability, and the team approach, the health center continued to have a large number of child admissions who reached the hospital without referral (the "leakers").

scholarly journals Quick Response Assessment of the Impact of an Extreme Storm Combining Aerial Drone and RTK GPS

2017 ◽  
Author(s):  
Arthur C. Trembanis ◽  
Enrico Duo ◽  
Stephanie Dohner ◽  
Edoardo Grottoli ◽  
Paolo Ciavola
Keyword(s):  
Warning System ◽  
Response Assessment ◽  
Storm Event ◽  
Quick Response ◽  
Aerial Photos ◽  
Extreme Storm ◽  
Rtk Gps ◽  
Commercial Off The Shelf ◽  
The Impact ◽  
Response Post

Abstract. Developing and implementing a quick response post-storm survey protocol has the potential to improve impact assessments of coastal storms. Pre- and post-event surveys are essential to properly quantify the storm impacts on the coast. In this study, a combination of traditional RTK GPS and Unmanned Aerial Vehicle drone platform was utilized as part of a coordinated storm response workflow. The comprehensive approach employed in this pilot case study was conducted on the Emilia-Romagna coast (Italy), in the immediate aftermath of an extreme storm event that impacted the shoreline on the 5th–6th February 2015 called the Saint Agatha Storm. The activities were supported by timing information on the approaching storm provided by the regional early warning system. We collected aerial photos from a commercial off-the-shelf drone immediately after the Saint Agatha Storm and generated both orthomosaic and digital elevation models utilizing structure-from-motion photogrammetry techniques. The drone- based survey approach allowed us to quickly survey an area of 0.25 km2 within a 10-minute flight resulting in a ground sampling distance of 2.5 cm/pixel. Flooding and erosion impacts are analyzed and presented for the target study area. Limitations and possible applications for coastal management of the quick response post-storm surveying protocol are highlighted.

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