scholarly journals Analyzing Acute Care Surgery Patient Flow in the Emergency Department During COVID-19 Pandemic

2021 ◽  
Author(s):  
Georgios Feretzakis ◽  
Georgios Karlis ◽  
Konstantinos Tsekouras ◽  
Stamatios Orfanos ◽  
Evangelos Loupelis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Surgery ◽  
Patient Flow ◽  
Tertiary Care ◽  
Control Period ◽  
Age Groups ◽  
Healthcare Facility ◽  
Acute Care Surgery ◽  
Chi Square ◽  
Surgery Patient

During the COVID-19 pandemic, the number of visits in emergency departments (ED) worldwide decreased significantly based on several studies. This study aims to compare the patient flow in the emergency surgery department during the COVID-19 pandemic and a control period in the emergency department of a public tertiary care hospital in Greece. The overall patient flow reduction regarding the ED visits between the two examined periods was 49.07%. The emergency surgery department’s corresponding visits were 235 and 552, respectively, which indicated an overall patient flow decrease of 57.43%. Chi-square analysis showed that age groups and ambulance use had statistically significant associations with the periods examined. An independent samples t-test was applied and deduced that the average patient’s age was statistically significantly higher in the COVID-19 pandemic than in the non-pandemic period. By analyzing hospital information system data, useful conclusions can be drawn to prepare a surgical emergency unit better and optimize resource allocation in a healthcare facility in similar critical situations.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

scholarly journals Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 189
Author(s):  
Mansour Tobaiqy ◽  
Bandar A. Asiri ◽  
Ahmed H. Sholan ◽  
Yahya A. Alzahrani ◽  
Ayed A. Alkatheeri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Acute Poisoning ◽  
Chi Square ◽  
Jeddah City ◽  
Policy And Strategy ◽  
Poisoning In Children

Background: Acute poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: This study aimed to evaluate the frequency and management of acute poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0–16 years of age) from October-21-2016 to March-03-2020 who were attending the emergency department. Data were analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning in children who attended the emergency department at East Jeddah Hospital; males (n = 38, 55.1%). Most children were aged 5 years or younger (n = 41, 59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (n = 5) of patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (chi-square = 28.5057, p = 0.0001). Most incidences occurred at home (n = 64, 92.8%). Medicines were the most common cause of poisoning (n = 53, 76.8%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8%). The most common route of poisoning was oral ingestion (81.2%). One mortality case was documented. Conclusion: Although not common, accidental and deliberate acute poisoning in children does occur. More can be done to educate parents on safe storage of medicines, household cleaning and other products associated with acute poisoning in children. Likewise, children can be taught more about the risks of poisoning from an early age. As importantly, clinicians need to include more detailed notes in the electronic medical records (EMR) or the system needs to be improved to encourage completeness to more accurately inform the research evidence-base for future service design, health policy and strategy.

scholarly journals Leucocyte count in children with complicated and uncomplicated acute appendicitis: a comparative study

2019 ◽  
Vol 6 (12) ◽  
pp. 4308
Author(s):  
Liya Joseph
Keyword(s):  
Acute Appendicitis ◽  
Leucocyte Count ◽  
Tertiary Care ◽  
Age Groups ◽  
Complicated Appendicitis ◽  
Total Leucocyte Count ◽  
Chi Square ◽  
Uncomplicated Appendicitis ◽  
Uncomplicated Acute Appendicitis ◽  
Complicated Acute Appendicitis

Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.

scholarly journals Changes in Emergency Department Performance during Strike of Junior Physicians in Korea

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jeongyong Sim ◽  
Yuri Choi ◽  
Jinwoo Jeong
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Control Period ◽  
Junior Doctors ◽  
And Performance ◽  
Almost All ◽  
Ed Operations ◽  
And Control

Objective. A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods. This retrospective observational study evaluated ED flow and performance during the junior doctors’ strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors’ strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results. A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors’ strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period P < 0.001 . The doctors’ strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion. During the junior doctors’ strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.

scholarly journals LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S11-S12
Author(s):  
I. Stiell ◽  
M. Taljaard ◽  
A. Forster ◽  
L. Mielniczuk ◽  
G. Wells ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Control Period ◽  
Care Hospital ◽  
Index Visit ◽  
Rapid Access

Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.

scholarly journals Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Agustin ◽  
Lori Lyn Price ◽  
Augustine Andoh-Duku ◽  
Peter LaCamera
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Included Study ◽  
Chi Square ◽  
Significant Difference ◽  
Protocol Compliance ◽  
Sepsis And Septic Shock ◽  
The Impact

Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p=0.68). Both groups have similar compliance with the 3-hour protocol (p=0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p=0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

scholarly journals Patient Flow at Emergency Department – The Safety Net of Health Care System

JMS SKIMS ◽  
2012 ◽  
Vol 15 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Farooq Ahmad Jan ◽  
Malik Aubid ◽  
Anil Manhas ◽  
Abdul Hakim ◽  
Amir Saeed Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Patient Flow ◽  
Systemic Disease ◽  
Tertiary Care ◽  
Safety Net ◽  
Tertiary Care Centre ◽  
Total Capacity ◽  
Care System

BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the safety net of the health care system. Unfortunately the increasing problem of crowding has strained this safety net to the breaking point according to some recent reports. OBJECTIVE: To study the patient flow at Emergency Department of a tertiary care centre. METHODS: This prospective study was carried over a period of two weeks at SKIMS in the month of December 2011. RESULTS: Of 175 patients attending on an average within twenty four hours to SKIMS emergency department, 22.3% of patients were admitted. 50 patients on an average were being treated at ED reception, the space which is meant for maximum of 16 patients. The hospital crowding was primarily regarded as a consequence of inadequate medical resources. Patients were seen more likely to leave without being seen when ED occupancy exceeded 100% of the total capacity. The shifting of admitted patients from ED depended on throughput factors in the parent speciality. It was also observed that patients who historically would be admitted through OPD would also find entry through ED. CONCLUSION: ED crowding is a local manifestation of a systemic disease. The focus has to be multipronged i.e., on Input, Throughput and Output Factors. While as control on input demands wider participation at multicentric community levels, hospitals can focus on the other two class of factors. There has to be clear focus on efficient use of inpatient resources. JMS 2012;15(2):132-35

scholarly journals Pattern of injuries in trauma patients presenting in Accident and Emergency Department of Jinnah Hospital, Lahore

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Kamran Ali ◽  
Ghulam Mustafa Arain ◽  
Ahmad Sohail Masood ◽  
Aslam M
Keyword(s):  
Emergency Department ◽  
Upper Limb ◽  
Lower Limb ◽  
Tertiary Care ◽  
Age Groups ◽  
Exploratory Laparotomy ◽  
The Body ◽  
Trauma Patients ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Objective: To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. Design: A prospective descriptive epidemiological study. Place and duration of study: Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. Subjects and methods: The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head & neck, thorax and perineum. Then frequency of different types of trauma was determined. Results: During this period (1st April2005 to 30th September 2005), 111`413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients (30%) had blunt trauma, 134(2.86%) had penetrating firearms injury, 2433(51.99%) had penetrating sharp injury an d 709 patients (15.15%) had crush injury. Most patients got upper limb, lower limb, head & neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients (71.36%) got only minor surgery like stitching under local anaesthesia and 468 patients (10%) had no surgery at all. 872 patients (18.63%) underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Conclusion: Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies.

Trends and repetition of non-fatal suicidal behaviour: analyses of the Gold Coast University Hospital’s Emergency Department

2018 ◽  
Vol 26 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Kairi Kõlves ◽  
David Crompton ◽  
Kathryn Turner ◽  
Nicolas JC Stapelberg ◽  
Ashar Khan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicidal Behaviour ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Age Groups ◽  
Cox Proportional Hazards ◽  
Gold Coast ◽  
First Year ◽  
Chi Square ◽  
Chi Square Test

Objective The aim of the current paper is to analyse time trends of non-fatal suicidal behaviour (NFSB) and its repetition at the Gold Coast in 2005–2015. Methods Data on presentations for NFSB were obtained from the Emergency Department (ED) Information System. Potential cases were identified through keyword searches, which were further scrutinised and coded. Annual person-based age-standardised rates for NFSB were calculated. Chi-square test, Poisson regression and Cox proportional hazards regression were used. Results: There was a significant increase in the age-standardised rates of NFSB for males (incidence Rate Ratio = 1.05; 95% confidence interval (CI): 1.04–1.07) and females (iRR = 1.06; 95% CI: 1.04–1.07). Age-specific rates showed significant increases for all age groups, except 25–34 and 55+ for females. Different types of poisoning were the predominant method of NFSB (poisoning only – 61.7% of episodes), followed by cutting (23%). Within the first year after the index episode, 13.4% of subjects repeated NFSB. Multivariate Cox regression model showed that sex, age and method predicted repetition. Conclusion: The increasing trends of NFSB and relatively high repetition rates emphasise the need for preventative actions. Monitoring of NFSB at the ED level should be further extended in Australia.

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