Acute intoxication cases admitted to the emergency department of a university hospital

Abstract Objectives This study aimed to describe the development and implementation of a separated pathway to check and treat patients with a suspected/confirmed coronavirus disease 2019 (COVID-19) in the emergency department (ED) at King Abdullah bin Abdulaziz University Hospital in Riyadh. Methods We conducted a retrospective, descriptive longitudinal study from March to July 2020 by analyzing data of all confirmed cases of COVID-19 among ED visitors and healthcare workers in King Abdullah bin Abdulaziz University Hospital. Results During the study period, a total of 1,182 swab samples were collected for testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 285 (24.1%) tested positive. Of the 285 cases of confirmed SARS-CoV-2 infection, 18 were healthcare workers and 267 were patients. As a result of using the respiratory pathway for COVID-19 patients, the hospital managed to limit transmission of SARS-CoV-2 not only between patients but also between patients and healthcare workers, while also containing the pandemic. There were no cases of nosocomial SARS-CoV-2 infection recorded among the patients who visited the ED or the flu clinic. All confirmed cases were community acquired and patients were cared for under constrained measures. Conclusions Implementing infection control measures and restricting those with respiratory symptoms to the ED pathway prevented nosocomial spread of SARS-CoV-2 infection in the ED.

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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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A rare encounter of obstructed direct inguinal hernia

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i2.28745 ◽

2019 ◽

Vol 22 (2) ◽

pp. 41-43

Author(s):

Amit Kumar Singh ◽

Nripesh Rajbhandari ◽

Balaram Malla ◽

Gakul Bhatta

Keyword(s):

Emergency Department ◽

Inguinal Hernia ◽

Intestinal Obstruction ◽

Intestinal Resection ◽

Posterior Wall ◽

Acute Intestinal Obstruction ◽

University Hospital ◽

Direct Inguinal Hernia ◽

Direct Hernia ◽

The Right

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids. The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall. Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

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Time is Money—the Economic Impact of Point of Care on the Emergency Department of a Tertiary Care University Hospital

Point of Care The Journal of Near-Patient Testing & Technology ◽

10.1097/poc.0000000000000003 ◽

2014 ◽

Vol 13 (1) ◽

pp. 21-23 ◽

Cited By ~ 4

Author(s):

Ulf Martin Schilling

Keyword(s):

Emergency Department ◽

Economic Impact ◽

Point Of Care ◽

Tertiary Care ◽

University Hospital

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Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival

Medical Sciences ◽

10.3390/medsci6040091 ◽

2018 ◽

Vol 6 (4) ◽

pp. 91

Author(s):

Leonor Ballester ◽

Rafael Martínez ◽

Juan Méndez ◽

Gloria Miró ◽

Manel Solsona ◽

...

Keyword(s):

Emergency Department ◽

Severe Sepsis ◽

Clinical Laboratory ◽

University Hospital ◽

Antibiotic Administration ◽

Process Of Care ◽

Sepsis Management ◽

Initial Management ◽

Sepsis Diagnosis ◽

Community Onset

Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.

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

International Journal of Academic Research ◽

10.7813/2075-4124.2014/6-2/a.8 ◽

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

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A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization

10.1101/2021.08.27.21262728 ◽

2021 ◽

Author(s):

Peter Liptak ◽

Peter Banovcin ◽

Robert Rosolanka ◽

Michal Prokopic ◽

Ivan Kocan ◽

...

Keyword(s):

Machine Learning ◽

Emergency Department ◽

Random Forest ◽

Gastrointestinal Symptoms ◽

Machine Learning Algorithms ◽

Important Predictor ◽

University Hospital ◽

Home Based ◽

Severity Of The Disease ◽

The University

Background and aim: COVID-19 can be presented with various gastrointestinal symptoms. Shortly after the pandemic outbreak several machine learning algorithms have been implemented to assess new diagnostic and therapeutic methods for this disease. Aim of this study is to assess gas-trointestinal and liver related predictive factors for SARS-CoV-2 associated risk of hospitalization. Methods: Data collection was based on questionnaire from the COVID-19 outpatient test center and from the emergency department at the University hospital in combination with data from inter-nal hospital information system and from the mobile application used for telemedicine follow-up of patients. For statistical analysis SARS-CoV-2 negative patients were considered as controls to three different SARS-CoV-2 positive patient groups (divided based on severity of the disease). Results: Total of 710 patients were enrolled in the study. Presence of diarrhea and nausea was significantly higher in emergency department group than in the COVID-19 outpatient test center. Among liver enzymes only aspartate transaminase (AST) has been significantly elevated in the hospitalized group compared to patients discharged home. Based on random forest algorithm, AST has been identified as the most important predictor followed by age or diabetes mellitus. Diarrhea and bloating have also predictive importance although much lower than AST. Conclusion: SARS-CoV-2 positivity is connected with isolated AST elevation and the level is linked with the severity of the disease. Furthermore, using machine learning random forest algo-rithm, we have identified elevated AST as the most important predictor for COVID-19 related hos-pitalizations.

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