scholarly journals Characteristics of patients hospitalised in an emergency department observation unit in Japan

2018 ◽  
Vol 14 (2) ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Yuhei Ohtaki ◽  
Nobuaki Kiriyama ◽  
Kei Ohtani ◽  
Wataru Yajima ◽  
...  
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Emergency Departments ◽  
Average Length ◽  
Developed Countries ◽  
The United States ◽  
University Hospital ◽  
Medical Systems ◽  
Average Length Of Stay ◽  
Emergency Medical Systems

In Japan, transporting elderly patients to emergency departments has recently posed serious problems, including a longer average time from patients’ initial emergency calls to their arrival at hospitals. To manage emergency departments more efficiently, many hospitals in the United States and some other developed countries, including Japan, introduced emergency department observation units (EDOU). However, because the usefulness of EDOUs in managing elderly patients remains uncertain, we analysed data of patients admitted to a Japanese university hospital’s EDOU to gauge its efficacy. We followed 1,426 patients admitted to the hospital’s EDOU from 1 January 2011 to 31 December 2014. The average age of patients who stayed in the EDOU increased, whereas the average length of time that they spent there decreased. Although the percentage of patients older than 65 years increased slightly, from 36.42% (2011–2012) to 37.73% (2013–2014), the proportion of those patients between the two periods did not significantly change (P = .61). Moreover, their average length of stay was 2.16 ± 0.91 days, whereas patients younger than 65 years stayed for significantly less time (1.92 ± 0.82 days). By condition, approximately 36% of patients older than 65 years presented with non-neurosurgical trauma, approximately 59% presented with other forms of trauma, but proportions of both categories of trauma were significantly smaller in patients younger than 65 years (nonneurosurgical trauma, 23%; all trauma, 47%). Most elderly patients with limb trauma prepped for surgery were transferred to other hospitals after a few days. Results suggest that the EDOU at the university hospital has served to as a buffer for regional emergency medical systems in Japan, especially given the continued ageing of the Japanese population.

scholarly journals 28 Can Comprehensive Geriatric Assessment be Achieved in the Emergency Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Cheng ◽  
C Ho ◽  
K Honney ◽  
M Wells ◽  
W Wise ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Average Length ◽  
University Hospital ◽  
Emergency Setting ◽  
Care Plans ◽  
Average Length Of Stay ◽  
Standard Tool ◽  
The Uk

Abstract Background Our National Health Service is facing unprecedented challenges to accommodate our frailer healthcare users. The gold standard tool for the identification and management of frailty is the Comprehensive Geriatric Assessment (CGA) and has been shown to lead to better outcomes in terms of morbidity and mortality. Introduction With a largely elderly demographic profile in the East of England, the Norfolk and Norwich University Hospital opened the first Older People’s Emergency Department (OPED) in the UK in 2017. This work reviews the effectiveness of a geriatrician-led CGA in a dedicated OPED, which operates during daylight hours, compared to usual care in Accident & Emergency (A&E). Methods 99 patients assessed in OPED and 99 patients assessed overnight in A&E during February 2019 were included in this retrospective study. Electronic case notes for each patient were reviewed by the authors and results were expressed as percentages. Results OPED outperformed A&E in all components of the CGA; strongest areas included assessing for pain, falls risk and activities of daily living. Both departments performed well in reviewing medications and assessing for safeguarding concerns. Areas for improvement include assessing for mood disorders, sensory impairment, discussing Do Not Attempt Cardiopulmonary Resuscitation status, and end of life care plans. The average length of stay of OPED patients was only 7.3 days compared to 8.7 days in A&E, and 89% of OPED patients were discharged back to their usual residences compared to 87% in A&E. Conclusions The improved CGA process in OPED has led to better outcomes, notably through a reduction in the average length of inpatient stay. Nevertheless, certain components of the CGA still require improvement. Further examination is needed to assess long-term mortality to support the use of CGA in the emergency setting.

scholarly journals Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions

2014 ◽  
Vol 52 (195) ◽  
pp. 878-885 ◽  
Author(s):  
Oya Durmus Cakir ◽  
Sebnem Eren Cevik ◽  
Mehtap Bulut ◽  
Ozlem Guneyses ◽  
Sule Akkose Aydin
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Waiting Times ◽  
Pediatric Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Average Length Of Stay ◽  
Bed Capacity

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.  Keywords: bed capacity; crowding; emergency department; length of stay.  

scholarly journals Emergency Surgery in A Tertiary Hospital: The Covid-19 Experience

2020 ◽  
Author(s):  
Gennaro Perrone ◽  
Mario Giuffrida ◽  
Elena Bonati ◽  
Paolo Del Rio ◽  
Vittoria Pattonieri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Acute Cholecystitis ◽  
Emergency Surgery ◽  
Average Length ◽  
Medical Science ◽  
University Hospital ◽  
Average Length Of Stay ◽  
The Impact

Objective: Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in an Emergency Department of a tertiary COVID-Hospital. Methods: We reported and compared the surgical procedures performed for acute appendicitis and acute cholecystitis between two periods (March and April 2019 and March and April 2020) at Emergency Surgery Department of Parma University Hospital, a tertiary COVID-Hospital. Results: A total of 72 patients underwent surgery between March and April 2019 and 36 between March and April 2020 for acute appendicitis and cholecystitis. The average length of stay was comparable in the two considered years for LA (4.23±1.69 days in 2019 versus 4.5±2.33 days in 2020). The average length of stay in patients with acute cholecystitis was 5.9±3.8 days in 2019 and 8.23±5.5 days in 2020(P=0.038). The average hospitalization was comparable with 2019 data (5.62±3.77 days)n March 2020;whereas, April 2020 was statistically significantly longer 10.5±6 days (P= 0.023). Conclusions: Half of the emergency centers reported a drop in the overall number of urgent cases as confirmed in our department, where the number of total appendicectomy and cholecystectomy was halved comparing the two months in 2019 and 2020, 72 operations in 2019 versus 36 operations in 2020.During the pandemic, the confidence of the population to the healthcare systems was poor, and this can explain the delayed access to the emergency department of patients who suffered from an acute illness. Bangladesh Journal of Medical Science Vol.19(0) 2020 p. S 66-S 68

Routine Emergency Department Use for Sick Care by Children in the United States

PEDIATRICS ◽  
1996 ◽  
Vol 98 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Neal Halfon ◽  
Paul W. Newacheck ◽  
David L. Wood ◽  
Robert F. St Peter
Keyword(s):  
High School ◽  
Emergency Department ◽  
Child Care ◽  
Emergency Departments ◽  
Primary Care Physicians ◽  
The United States ◽  
Health Maintenance ◽  
Well Child Care ◽  
Usual Source ◽  
Us Children

Background. The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. Methods. Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. Results. In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care.

Tracking the Rise of Geriatric Emergency Departments in the United States

2018 ◽  
Vol 39 (8) ◽  
pp. 871-879 ◽  
Author(s):  
John G. Schumacher ◽  
Jon Mark Hirshon ◽  
Phillip Magidson ◽  
Marilyn Chrisman ◽  
Terisita Hogan
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Emergency Departments ◽  
The United States ◽  
Transitions Of Care ◽  
Emergency Department Care ◽  
Equipment And Supplies ◽  
Care Services ◽  
Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

The analysis of elderly patients admitted to the emergency department of a university hospital in Turkey

2014 ◽  
Vol 6 (2) ◽  
pp. 46-51
Author(s):  
Ahmet Tugrul Zeytin ◽  
Arif Alper Cevik ◽  
Nurdan Acar ◽  
Seyhmus Kaya ◽  
Hamit Ozcelik
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
University Hospital

scholarly journals Ebola virus disease: Case management in the Institute of Infectious Diseases, University Hospital of Sassari, Sardinia, Italy

2016 ◽  
Vol 10 (05) ◽  
pp. 537-543 ◽  
Author(s):  
Giulia Bertoli ◽  
Marco Mannazzu ◽  
Giordano Madeddu ◽  
Riccardo Are ◽  
Alberto Muredda ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Ebola Virus ◽  
Virus Disease ◽  
Developed Countries ◽  
The United States ◽  
Ebola Virus Disease ◽  
University Hospital ◽  
Governmental Organization ◽  
Medical Division ◽  
Disease Case

Since the onset of the worst epidemic of Ebola virus disease in December 2013, 28,637 cases were reported as confirmed, probable, or suspected. Since the week of 3 January 2016, no more cases have been reported. The total number of deaths have amounted to 11,315 (39.5%). In developed countries, seven cases have been diagnosed: four in the United States, one in Spain, one in the United Kingdom, and one in Italy. On 20 July 2015, Italy was declared Ebola-free. On 9 May 2015, an Italian health worker came back to Italy after a long stay in Sierra Leone working for a non-governmental organization. Forty-eight hours after his arrival, he noticed headache, weakness, muscle pains, and slight fever. The following day, he was safely transported to the Infectious Diseases Unit of University Hospital of Sassari. The patient was hospitalized for 19 hours until an Italian Air Force medical division transferred him to Rome, to the Lazzaro Spallanzani Institute. Nineteen people who had contacts with the patient were monitored daily for 21 days by the Public Health Office of Sassari and none presented any symptoms. So far, neither vaccine nor treatment is available to be proposed on an international scale. Ebola is considered a re-emerging infectious disease which, unlike in the past, has been a worldwide emergency. This case study aimed to establish a discussion about the operative and logistic difficulties to be faced and about the discrepancy arising when protocols clash with the reality of facts.

Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met?

PEDIATRICS ◽  
1984 ◽  
Vol 73 (6) ◽  
pp. 769-772
Author(s):  
James S. Seidel ◽  
Mark Hornbein ◽  
Kathy Yoshiyama ◽  
Dorothy Kuznets ◽  
Jerry Z. Finklestein ◽  
...  
Keyword(s):  
Los Angeles ◽  
Death Rate ◽  
The United States ◽  
Base Station ◽  
Medical Systems ◽  
Medical Problems ◽  
Emergency Medical ◽  
Mobile Intensive Care Unit ◽  
Critically Ill Child ◽  
Emergency Medical Systems

Emergency medical systems are being developed throughout the United States primarily to deal with myocardial infarction and trauma. These programs often fail to recognize the special needs of the critically ill child. Data collected in Los Angeles County from the LA County Trauma Surveys, Mobile Intensive Care Unit Rescue Reports, and Base Station Hospitals demonstrate that children represent approximately 10% of the paramedic calls. The calls are for medical problems as well as trauma. These data suggest that children have a higher death rate in the field than adults, and deaths occur more commonly in areas where there are no pediatric centers. Children are often secondarily transferred from emergency departments to other centers for definitive care. This study suggests that the needs of children in the prehospital setting are not being met.

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