Evaluation of the Confidence and Competency of House Officers in Rapid Sequence Intubation (ECCHO-RSI) in Emergency Department of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre during COVID-19 Pandemic

Rapid sequence intubation (RSI) is a procedural skill that house officers (HO) in Malaysia need to learn during their training in emergency department (ED) posting. This study aimed to evaluate the confidence and competency of HO in RSI after completed training in the ED of a university hospital during the COVID-19 pandemic. A prospective cross-sectional study was conducted among 44 HO. When they begin their posting in ED, a pre-test was done with a questionnaire to evaluate their knowledge and confidence level. A post-test was conducted three months later with a similar questionnaire. They underwent an objective structured clinical examination to evaluate their skill. A feedback survey form was filled in by the HO regarding their satisfaction in training in emergency rotation. The mean score for pre-test and post-test were 8.75 ± 3.005 and 14.86 ± 2.258, respectively (P = 0.000). There was an improvement in knowledge level and confidence level between pre-test and post-test (all P = 0.000). 43.2% were competent in knowledge, while 65.9% were competent in skill. 35 house officers filled in the feedback survey form. It showed that 42.9% (n = 15) were very satisfied and 28.6% (n = 10) were satisfied with the training in ED. There was an improvement in knowledge and confidence level in RSI among the HO after ED rotation. The clinical exposure in intubating real patients was limited among HO due to the COVID-19 pandemic. The training of HO for RSI in ED needs to be further improvised to optimize their learning process.

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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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Feasibility and Success of Hiv Point-of-Care Testing in an Emergency Department in an Urban Canadian Setting

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2013/164797 ◽

2013 ◽

Vol 24 (1) ◽

pp. 27-31 ◽

Cited By ~ 15

Author(s):

Marissa L Becker ◽

Laura H Thompson ◽

Carla Pindera ◽

Natalie Bridger ◽

Carmen Lopez ◽

...

Keyword(s):

Emergency Department ◽

Hiv Testing ◽

Point Of Care ◽

Venous Blood ◽

Tertiary Care ◽

Antibody Test ◽

Cross Sectional Study ◽

Cross Sectional ◽

Post Test ◽

Centre Hospital

BACKGROUND: Approximately 26% of Canadians living with HIV are unaware of their status. Point-of-care (POC) HIV tests have been introduced to simplify and expand HIV testing.OBJECTIVE: To evaluate the feasibility and acceptability of POC testing in an emergency department (ED) setting in Winnipeg, Manitoba.METHODS: A cross-sectional study of unselected adults presenting to the ED at the Health Sciences Centre Hospital (Winnipeg, Manitoba) was performed. Study procedures included pre- and post-test counselling, administration of the INSTI HIV-1/HIV-2 Antibody Test (bioLytical Laboratories, Canada) and a brief questionnaire. Venous blood samples were collected from participants for confirmatory testing on all reactive and indeterminate specimens.RESULTS: In total, 501 adults participated in the study. The majority of participants were younger than 40 years of age, approximately one-half (48.5%) were women and 53% self-identified as Aboriginal. Nearly one-half (49.1%) of the participants had undergone previous HIV testing, although 63% of these tests were performed more than a year earlier. A total of seven individuals tested reactive with the POC test, all of whom were confirmed positive using serological testing (1.4%) and were linked to an HIV specialist within 24 h. Nearly all of the participants (96%) reported satisfaction with the test and believed it belonged in the ED (93%).CONCLUSIONS: Of the participants tested, 1.4% tested reactive for HIV, which is significantly higher than the reported prevalence in Manitoba and in other similar studies conducted in North America. Furthermore, all individuals were linked to timely care. The present study demonstrated that this particular busy tertiary care ED is an important and feasible location for HIV POC testing.

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Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0252044 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252044

Author(s):

Doaa Mahmoud Khalil ◽

Elmorsy Elmorsy ◽

Ahmed Arafa ◽

Hesham Ahmed Nafady ◽

Lamiaa Saleh

Keyword(s):

Emergency Department ◽

Time Delay ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Factors Affecting ◽

Consciousness Level ◽

Injured Patients ◽

Prehospital Time

Purpose This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt. Materials and methods In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury. Results The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26–11.68), 3.49 (2.22–5.48), and 0.56 (0.32–0.96), respectively. Conclusion The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.

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Suicide attempts in emergency department

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.351 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S170-S170

Author(s):

K. Hajji ◽

I. Marrag ◽

R. Ben soussia ◽

L. Zarrouk ◽

S. Younes ◽

...

Keyword(s):

Emergency Department ◽

Clinical Characteristics ◽

Suicide Attempts ◽

Cross Sectional Study ◽

University Hospital ◽

Medical Emergency ◽

Cross Sectional ◽

Adequate Care ◽

Competing Interest ◽

The University

IntroductionThe suicide attempt is a real challenge for the clinician who works at the emergency department in order to identify and propose an adequate care.AimsTo estimate the prevalence of the suicide attempts, to describe the sociodemographic and clinical characteristics and to identify the predictors of recurrence.MethodsOur cross-sectional study was conducted at the medical emergency department of the university hospital of Mahdia and lasted for 12 months. Data were collected using a questionnaire of 51 items exploring the general and clinical characteristics and providing information of the treatment.ResultsAmong the 513 consultants, 90 had attempted suicide (17,5%). We found an average age of 26 years old, a sex-ratio (M/F) of 0,3, a secondary education level (53,3%), an unemployment and a single status (38,9% and 75,6%). The presence of psychiatric personal history and/or suicide attempts was found in 31,1% and 33,3% of cases. Suicide attempts were taken place in all cases at home, between 18 and midnight (43,3%), without premeditation (82,2%), in the presence of triggering factor (95,6%), during the last 3 months of the year (34,4%). In 70,2% of cases, the type of the suicide attempts was a drug intoxication. 67,8% of the suicide attempters regretted and criticized their acts.ConclusionA good assessment of the suicide risk determines the type of intervention that should be established and allows an adequate care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Assessment of patient safety challenges and electronic occurrence variance reporting (e-OVR) barriers facing physicians and nurses in the emergency department: a cross sectional study

BMC Emergency Medicine ◽

10.1186/s12873-020-00391-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ahmed I. Albarrak ◽

Ammar S. Almansour ◽

Ali A. Alzahrani ◽

Abdulaziz H. Almalki ◽

Abdulrahman A. Alshehri ◽

...

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Electronic Reporting ◽

Chi Square Test ◽

Usability Data

Abstract Background The purpose of patient safety is to prevent harm occurring in the healthcare system. Patient safety is improved by the use of a reporting system in which healthcare workers can document and learn from incidents, and thus prevent potential medical errors. The present study aimed to determine patient safety challenges facing clinicians (physicians and nurses) in emergency medicine and to assess barriers to using e-OVR (electronic occurrence variance reporting). Methods This cross-sectional study involved physicians and nurses in the emergency department (ED) at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. Using convenience sampling, a self-administered questionnaire was distributed to 294 clinicians working in the ED. The questionnaire consisted of items pertaining to patient safety and e-OVR usability. Data were analyzed using frequencies, means, and percentages, and the chi-square test was used for comparison. Results A total of 197 participants completed the questionnaire (67% response rate) of which 48 were physicians (24%) and 149 nurses (76%). Only 39% of participants thought that there was enough staff to handle work in the ED. Roughly half (48%) of participants spoke up when something negatively affected patient safety, and 61% admitted that they sometimes missed important patient care information during shift changes. Two-thirds (66%) of the participants reported experiencing violence. Regarding e-OVR, 31% of participants found reporting to be time consuming. Most (85%) participants agreed that e-OVR training regarding knowledge and skills was sufficient. Physicians reported lower knowledge levels regarding how to access (46%) and how to use (44%) e-OVR compared to nurses (98 and 95%, respectively; p < 0.01). Less than a quarter of the staff did not receive timely feedback after reporting. Regarding overall satisfaction with e-OVR, only 25% of physicians were generally satisfied compared to nearly half (52%) of nurses. Conclusion Although patient safety is well emphasized in clinical practice, especially in the ED, many factors hinder patient safety. More awareness is needed to eliminate violence and to emphasize the needs of additional staff in the ED. Electronic reporting and documentation of incidents should be well supported by continuous staff training, help, and feedback.

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Fear of COVID-19 among pregnant women in Pakistan: a cross-sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205145 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4749

Author(s):

Sidrah Nausheen ◽

Shelia Bhamani ◽

Areeba Makhdoom ◽

Lumaan Sheikh

Keyword(s):

Pregnant Women ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Survey Tool ◽

Low Socioeconomic ◽

Healthcare Settings ◽

Survey Form ◽

High Level

Background: The emergence of COVID-19 and its pandemic nature has exacerbated fears worldwide. Pregnant women are considered a vulnerable group during the COVID-19 pandemic because the physiological changes make them more susceptible to infections. Pregnant women are found expressing much of the fear related to their course of pregnancy, the in-utero transmission of the disease, and questions related to infection control in healthcare settings. Hence, the purpose of this paper was to explore the fears faced by pregnant women related to COVID.Methods: It was a cross-sectional survey among 201 pregnant women attending antenatal clinics of Aga Khan University Hospital. The survey tool contains demographic variables and a 7-item scale of “Fear in COVID” which is pre tested in the Iranian population. The survey form was made on google drive and sent to pregnant females on WhatsApp.Results: 201 pregnant women mostly belonging to middle and low socioeconomic class were enrolled. The majority (80%) of women were less than 30 years of age. Only 26 (12.9%) were primigravids, remaining were multigravidas of a different order of pregnancy. 60% of our study population showed high fear scores (27-35) from coronavirus whereas another 30% had moderate fear. No association of study variables was found with fear scores.Conclusions: We found a high level of fear of COVID-19 among the pregnant population with a higher level of anxiety and stress related symptoms. The amount of fear and stress is independent of the trimester or order of pregnancy.

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Clinical presentation of pulmonary embolism among patients in the emergency department

Dansk Tidsskrift for Akutmedicin ◽

10.7146/akut.v2i3.112986 ◽

2019 ◽

Vol 2 (3) ◽

pp. 44

Author(s):

Giti Nadim

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Clinical Presentation ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Main Symptom ◽

Wide Range ◽

Icd 10 ◽

Health Registry

Background: Pulmonary embolism (PE) is an important clinical entity known to cause a wide range of symptoms. Morbidity and mortality of PE are high. However, knowledge of symptomatology is sparse. Aim: To elucidate the clinical presentation of emergency department (ED) patients diagnosed with PE. Methods: We carried out a cross-sectional study of adult patients attending the EDs at Odense University Hospital and Hospital of Southwest Jutland. The main symptom at presentation was prospectively registered. ED and hospital discharge diagnosis was sampled from the Danish national health registry. Patients with PE were identified based on discharge diagnoses (ICD-10 code I26.0 or I26.9) from the ED or following hospitalization. Results: Among 24,124 contacts to the EDs, 322 (1.3%) were diagnosed with PE. The main presenting symptom was respiratory distress (31%; n=101), while 26% (n=85) had symptoms suspicious of heart disease such as dyspnea of cardiac cause, chest pain and palpitation, 8% (n=27) fainting / syncope or suspected neurological disorders, 8% (n=26) pain in the lower limb, and 6% (n=18) had fever as their main symptom. Conclusion: PE patients have a wide variety of symptoms and most PE patients present with other symptoms than dyspnea.

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Prevalence and Characteristics of Staphylococcus aureus Colonization among Healthcare Professionals in an Urban Teaching Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/652525 ◽

2010 ◽

Vol 31 (6) ◽

pp. 574-580 ◽

Cited By ~ 38

Author(s):

Marie-Carmelle Elie-Turenne ◽

Helen Fernandes ◽

José R. Mediavilla ◽

Marnie Rosenthal ◽

Barun Mathema ◽

...

Keyword(s):

Emergency Department ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Healthcare Professionals ◽

Methicillin Resistance ◽

Tertiary Care ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Clerical Workers

Objective.To determine the prevalence of asymptomatic carriage of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) among healthcare professionals (HCPs) who experience varying degrees of exposure to ambulatory patients and to genetically characterize isolates.Methods.This single-center, cross-sectional study enrolled 256 staff from the intensive care units, emergency department, and prehospital services of an urban tertiary care university hospital in 2008. Occupational histories and nasal samples for S. aureus cultures were obtained. S. aureus isolates were genetically characterized with the use of spa typing and screened for mecA. MRSA isolates underwent further characterization.Results.S. aureus was isolated from 112 of 256 (43.8%) HCPs, including 30 of 52 (57.7%) paramedics, 51 of 124 (41.1%) nurses, 11 of 28 (39.3%) clerical workers, and 20 of 52 (38.5%) physicians. MRSA was isolated from 17 (6.6%) HCPs, including 1 (1.9%) paramedic, 13 (10.5%) nurses, 1 (3.6%) clerical worker, and 2 (3.8%) physicians. Among S. aureus isolates, 15.2% were MRSA. MRSA prevalence was 9.6% (12/125) in emergency department workers, 5.1% (4/79) in intensive care unit workers, and 1.9% (1/52) in emergency medical services workers. Compared with paramedics, who had the lowest prevalence of methicillin resistance among S. aureus isolates (1 of 30 [3.3%] isolates), nurses, who had the highest prevalence (13 of 51 [25.4%] isolates), had an odds ratio of 9.92 (95% confidence interval, 1.32-435.86; P = .02) for methicillin resistance. Analysis of 15 MRSA isolates revealed 7 USA100 strains, 6 USA300 strains, 1 USA800 strain, and 1 EMRSA-15 strain. All USA300 strains were isolated from emergency department personnel.Conclusions.The observed prevalence of S. aureus and MRSA colonization among HCPs exceeds previously reported prevalences in the general population. The proportion of community-associated MRSA among all MRSA in this colonized HCP cohort reflects the distribution of the USA300 community-associated strain observed increasingly among US hospitalized patients.

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Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-417 ◽

2021 ◽

pp. 1-10

Author(s):

Nazir Najeeb Kapadia ◽

Emaduddin Siddiqui

Keyword(s):

Emergency Department ◽

Acute Pancreatitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Sampling Technique ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Mild Acute Pancreatitis ◽

Ranson Score

Abstract Objective: To determine diagnostic accuracy of BISAP in comparison to Ranson scores in predicting mortalities and severities in patients with acute pancreatitis coming to the emergency department. Methods: Cross-sectional study conducted in Department of Emergency Medicine, Aga Khan University Hospital, Stadium road Karachi, Pakistan. 136 patients were selected via non-probability consecutive sampling technique, those who fulfilled the criteria of inclusion. BISAP score was applied in the emergency department (ED) & the patients were followed in ward/intensive care unit where Ranson scores were calculated in the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. All the obtained data was recorded in Performa. Results: In this study 136 patients, who fulfill the inclusion criteria were selected. On the basis of BISAP and Ranson score; mild acute pancreatitis to moderate acute pancreatitis (MAP to ModAP) was diagnosed in 123 (90.4%) and 119 (87.5) patients and severe AP (SAP) in 13 (9.6%) and 17 (12.5%) patients respectively. Specificity (Sp) 94.62% vs 91.54%, Sensitivity (Sn) 100.0% vs 100.0%, negative predictive value (NPV) 100.0% vs 100.0%, positive predictive value (PPV) 46.15% vs 35.29% and diagnostic accuracy (DA) 94.85% vs 91.91% of BISAP vs Ranson scores respectively. Conclusion: It was concluded from the study that BISAP and Ranson score are very reliable tool for identification of acute pancreatitis patients at higher risk of severity and mortality. BISAP and Ranson score has same sensitivity but BISAP score has higher specificity than Ranson score. Continuous...

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