Emergency  service  units  in Turkey dont  have enough  resources  to implement  the one- hour sepsis bundle components  and   sepsis guidelines recommendations, 238 emergency  department  directors opinion

The purpose of this article is to give an overview of the actual emergency medical attendance through an exemplary hospital in Hungary, highlighting its possible imperfections which could perhaps be improved through further structural developments. In order to be expressive, the article follows through the journey of two nominal patients who turned up in the emergency department of the hospital. The importance of this topic is expressed by the fitful judgment of the emergency attendance. Emergency service had already existed in the United States, only later then did the one-entrance service system start to develop Hungary. In some places this system has been working well for decades, but for instance at the University of Szeged – due to the uncertain judgment of the system – the construction is just being finalized, right at the time when such studies are published that question the reason of existence of the emergency departments – at least in their actual form.

Download Full-text

Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative

CJEM ◽

10.1017/cem.2016.351 ◽

2016 ◽

Vol 19 (2) ◽

pp. 112-121 ◽

Cited By ~ 10

Author(s):

Tamara McColl ◽

Mathieu Gatien ◽

Lisa Calder ◽

Krishan Yadav ◽

Ryan Tam ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Intervention Group ◽

Critical Conditions ◽

Absolute Difference ◽

Antibiotic Administration ◽

Post Intervention ◽

Sepsis Management ◽

Sepsis Bundle ◽

Post Intervention Group

AbstractBackgroundIn 2008–2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality.MethodsThis before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use.ResultsWe included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8–17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1–65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission.InterpretationThe implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.

Download Full-text

PP19 Opioid Poisoning Deaths: A National Picture

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318001915 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 73-73

Author(s):

Matthew Jones ◽

Helen Snooks ◽

Bridie Evans ◽

Alan Watkins ◽

Gordon Fuller

Keyword(s):

Emergency Department ◽

Service Utilization ◽

Linked Data ◽

Emergency Service ◽

Clinical Presentation ◽

Published Data ◽

Autopsy Study ◽

Female Age ◽

Diagnostic Codes ◽

Poisoning Deaths

Introduction:The factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents (a term used for people who are deceased) of opioid poisoning in Wales in 2015. Using anonymized linked data, we describe demographic characteristics, patterns of emergency service utilization, and clinical presentation prior to death.Methods:Decedents of opioid poisoning in Wales in 2015 were identified from the Office of National Statistics (ONS) mortality dataset. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymized Information Linkage (SAIL) databank. The data were accessed and analyzed in the SAIL gateway.Results:Age at death ranged from eighteen to seventy-eight years, with a mean age of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-three percent of decedents were men (n = 228/312). Eight-seven percent of decedents (n = 281/312) attended the emergency department in the three years prior to death. In total 2081 attendances were made, forty-one percent of which involved conveyance by ambulance. Attendances per individual ranged from one to 114, with over half of decedents attending more than three times. Diagnostic codes were mostly missing or non-specific, with only seven and a half percent of attendances representing eighty-two decedents, coded as drug related. Treatment codes were also mostly missing or non-specific, with sixteen percent of attendances representing 148 attendees attributed a treatment code. Thirty-nine percent of attendances (n = 822) ended in treatment and discharge, whilst twenty-seven percent (n = 562) led to hospital admission.Conclusions:Matching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilization. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.

Download Full-text

Substance/Medication-Induced Mood Disorders and Co-occuring Mood and Substance Use Disorders: Evaluation and Management in Emergency Department and Psychiatric Emergency Service Settings

Substance Use and the Acute Psychiatric Patient - Current Clinical Psychiatry ◽

10.1007/978-3-319-23961-3_6 ◽

2019 ◽

pp. 95-110 ◽

Cited By ~ 1

Author(s):

Lior Givon

Keyword(s):

Emergency Department ◽

Substance Use ◽

Mood Disorders ◽

Substance Use Disorders ◽

Emergency Service ◽

Psychiatric Emergency ◽

Psychiatric Emergency Service ◽

Induced Mood

Download Full-text

Anorexia nervosa and attachment

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.785 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S552-S552

Author(s):

H. De la Red Gallego ◽

A. Alonso Sánchez ◽

A. Álvarez Astorga ◽

S. Gómez Sánchez ◽

L. Rodríguez Andrés ◽

...

Keyword(s):

Emergency Department ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Clinical Case ◽

Cognitive Distortions ◽

Insecure Attachment ◽

Weight Restoration ◽

Competing Interest ◽

The One

IntroductionAttachment is an innate programming whereby a child seeks for security. There is scientific and empirical evidence that insecure attachment is usual in eating disorder patients [1].ObjectivesTo highlight the relevance of attachment between child and caregivers, as well as its significance in therapeutic approach.MethodsA 17-year-old girl hospitalized after attending to emergency department due to fainting. BMI: 12.89. She reports restrictive behavior since age 11 that her mother regards as “child issues”. Divorced parents, she grew up with her mother, diagnosed of hypochondria, who mentions not understanding why she is not the one who is hospitalized.ResultsDuring hospitalization, she turned 18-years-old. Guardianship of her younger siblings was removed to her mother. She had a secure relationship with her 24-year-old sister, so she decided to move in with her. Later on, she had a positive progress, maintaining the gained weight and mood stability, although cognitive distortions persist.ConclusionsAmong developmental and maintaining factors of eating disorders, impaired attachment is becoming increasingly interesting. Even though the main goal of treatment is weight restoration, exploring attachment patterns can facilitate to achieve that aim. This clinical case emphasizes the importance of attachment in eating disorders among child and young adults.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text