Estimation of the nurse-to-patient optimal ratio in the emergency department based on workload: OPTIRATIO Study.

Structural complexity shapes the behavior and abundance of a common herbivorous fish, increasing herbivory on a turf-dominated, fringing reef

Summary The purpose of this study is to show how the 3D DAS (distributed acoustic sensing) VSP (vertical seismic profile) technology can benefit the daily work of geoscientists in areas of high geological complexity. The 3D DAS VSP seismic is particularly useful not only because of operational advantages (type of installation, quick deployment, lower cost, execution during production, among others) but mainly due to enhanced seismic imaging such as superior resolution and higher frequency content, that allows the improvement of all geophysical and geological workflows, as well as a better correlation between the conventional seismic data and well log data, in a multi-scale integration approach. This enhancement is particulary relevant in areas of high complexity in geological settings and reservoirs, and permits a more detailed geophysical and geological analysis. In this study, the results obtained from the geophysical analysis of the 3D DAS VSP were integrated with the field model and used to propose, validate, and steer new well locations in the area of interest, demonstrating the value of incorporating this technology within more traditional methods.

Performance of the Canadian Triage and Acuity Scale for Children: A Multicenter Database Study

The Canadian Triage and Acuity Scale for Children: A Prospective Multicenter Evaluation

Overcrowding in emergency departments is a serious public health issue. Recent studies have reported that overcrowding in emergency departments affects not only the quality of emergency care but also clinical decisions about admission. However, no studies have examined the characteristics of the patient groups whose admission rate is influenced by such overcrowding. This retrospective cohort study was conducted in a single emergency department between January 1 and December 31, 2018. Patients over 19 years old were enrolled and divided into three groups according to the degree of overcrowding—high, low, and non—based on the total number of patients in the emergency department. An emergency triage tool (the Korean Triage and Acuity Scale) was used, which categorizes patients into five different levels. We analyzed whether the degree of change in the admission rate according to the extent of overcrowding differed for each triage group. There were 73,776 patients in this study. In the analysis of all patient groups, the admission rate increased as the degree of overcrowding rose (the adjusted odds ratio for admission was 1.281 (1.225–1.339) in the high overcrowding group versus the non-overcrowding group). The analysis of the patients in each triage level showed an increase in the admission rate associated with the overcrowding, which was greater in the patient groups with a lower triage level (adjusted odds ratios for admission in the high overcrowding group versus non-overcrowding group: Korean Triage and Acuity Scale level 3 = 1.215 [1.120–1.317], level 4 = 1.294 [1.211–1.382], and level 5 = 1.954 [1.614–2.365]).

以事件存活分析、儲列模型及多階段模型探討急診病患滯留時間、處理流程、及影響因子分析

Introduction:Based on the existing standards, patients presenting to emergency department (ED) should receive a decision in a maximum of 6 hours after admission to ED and leave ED in this time. Unfortunately, most of the time, especially in general and referral hospitals, we witness patients staying in the ED for hours or even days after a decision has been made.Objective: the present study was performed with the aim of evaluating the causes of patients’ prolonged length of stay in ED of one of the major hospitals in Tehran, Iran. Method: The present cross-sectional action research was carried out in the ED of Imam Khomeini Hospital, Tehran, Iran, in November and December 2016. The studied population consisted of patients who stayed in ED for more than 12 hours. In a panel consist of specialists, semi-structured and open questions were asked from the participants. All the interviews were recorded and converted to text. Effective factors of staying more than 12 hours in ED mentioned by the interviewees were extracted. A checklist of evaluating the causes of more than 12 hours stay in ED was prepared. In the next stage, by daily visit to the ED of the studied hospital, profile of the patients who had stayed in the ED for more than 12 hours was evaluated and the variables determined in the checklist were assessed.Results: In the present study, 407 patients with the mean age of 54.07±20.18 years (minimum 1 and maximum 113 years) were studied, 270 (65.7%) of which were male. Respectively, 26 (6.4%) were admitted in triage level 1, 203 (49.9%) in triage level 2, 168 (41.3%) in triage level 3, 9 (2.2%) in triage level 4 and 1 (0.2%) in triage level 5. Based on these findings, “services not wanting to transfer patients with decisions to the service” was the most common factor.Conclusion:In the present study, specialized services not tending to dislocate the patients that have been decided upon to their respective department, a considerable number of complicated patients and patients with advanced underlying illnesses among those presenting to ED, and shortage of beds in specialized departments and ICU, were the most common causes affecting more than 12 hours stay of patients in the studied ED.

BackgroundMost Swedish emergency departments (ED) use the triage system Rapid Emergency Triage and Treatment System (RETTS©), which over time has proven to prioritize patients to higher triage levels. When many patients are prioritized to high triage levels, challenges with identifying true high-risk patients and increased waiting time for these patients has emerged. In order to achieve a more balanced triage in relation to actual medical risk, the triage system WEst coast System for Triage (WEST) was developed, based on the South African Triage Scale (SATS). The aim of this study was to perform an initial evaluation of the novel emergency triage system WEST compared to the existing RETTS©.MethodsBoth RETTS© and WEST are five level triage systems illustrated by colors. Nurses from each of the three adult EDs of Sahlgrenska University Hospital in Gothenburg and the ambulance service assessed and triaged 1510 patients according to RETTS© and immediately thereafter filled out the WEST triage form. Data from each triage report were analyzed and grouped according to the triage color, chief complaint, and outcome of each patient. Data on discharge categories and events within 72 h were also collected. Data were analyzed with descriptive statistical methods.ResultsIn general, WEST displayed lower levels of prioritization compared to RETTS©, with no observed impact on patients’ medical outcomes. In RETTS© orange triage level, approximately 50% of the patients were down prioritized in WEST to yellow or green triage levels. Also, in the RETTS© yellow triage level, more than 55% were down prioritized to green triage level in WEST. The number of patients who experienced a serious event during the first 72 h was few. Three patients died, these were all prioritized to red triage level in RETTS©. In WEST two of these patients were prioritized to red triage level and one to orange triage level. All these patients were admitted to hospital before deterioration.ConclusionsWEST may reduce over prioritization at the ED, especially in the orange and yellow triage levels of RETTS©, with no observed increase in medical risk. WEST can be recommended for a clinical comparative study.

Study Objective: The aims of this study were to analysis the relationship between the various severity triage levels and time expenditure in an emergency department (ED). This involved the analysis of time expended on the different triage level patients during rush or non-rush periods. Materials and Methods: The medical records of 400 patients were collected from the ED at the Mackay Memorial Hospital and retrospectively reviewed. The subjects were divided into different stages based on their progress through the ED. Recorded data included triage assessment, the different times expended at the different stages of treatment in the ED including triage assessment, registration, doctor's attendance and laboratory data examination and the arrival/departure times ofr the patients. Results: When the study groups were compared, there were significant differences between triage levels 1 patients compared to triage level 2 and 3 patients (p＜0.05) for all treatment stage times other than triage/ registration and the wait for initial physician attendance. In addition, overall, triage/registration and waiting for attendance times did not differ between the rush and non-rush periods. However, Level 1 triage patients took longer for all other timings during rush periods compared to non-rush periods (p＜0.05). Furthermore, level 2 and 3 triage patients took longer for triage and registration during rush periods compared to non-rush periods (p＜0.05). Conclusion: Typically, triage level 1 patients are more complex and require a longer diagnostic times than either level 2 or level 3 patients. Although disease/injury severity determines treatment priority, no such discrimination is used in less severe cases. This study indicates that level 1 cases use up much more time than level 2 and 3 for both doctor and laboratory examinations, but there is no increase in the waiting time for doctors during rush periods. Triage level 2 or 3 patients seem to have similar times for most activities except registration whether the ED is busy or not. It can therefore be concluded that improving procedures or setting up a team specifically for patients who are severely injured and who arrive during a busy periods may be helpful and reduce the risk of any delay in treatment of these patients, which is very important to every ED physician.

Aim: To analyse the degree of compliance of the care times of hospital emergency departments (EDs) in Spain with the recommended standards and their evolution during the SARS-CoV-2 pandemic.Design and Methods: An observational, correlational, cross-sectional and retrospective study was carried out. All adult patients attended in the EDs of 8 Spanish public hospitals from 2018 to 2021 were consecutively included. The main variables were time spent in the ED, time to triage, waiting time until the start of care, triage level, classified according to the Spanish Triage System and year of care. Other sociodemographic variables were collected, in addition to discharge destination. For each triage level, a negative binomial regression model was performed, adjusted for year, hospital and waiting times. The analysis was performed with R 4.2.2 software.Results: A total of 2,282,555 patients were included; ED lengths of stay varied according to triage levels: Level 1, 21.6 h; Level 2, 26.3 h; Level 3, 22.2 h; Level 4, 8.1 h and Level 5, 10.3 h. Statistically significant differences were detected only in 2021, in all hospitals and from priority Level 2–5. An increase in dwell times was observed in all hospitals, with longer dwell times in high complexity hospitals. Longer waiting times at triage Levels 3, 4 and 5 presented a higher risk of mortality. The percentage of patients leaving the ED was high (3.6%).Conclusions: The degree of compliance with ED care times according to recommended standards was low. The dropout rate, waiting times for initial triage and ED attendance were higher than desired. The SARS-CoV-2 pandemic changed the pattern of ED visits, decreasing the frequentation of patients, but did not decrease the length of stay in the ED. This pattern normalised the following year.

BackgroundThe emergency department (ED) receives patients from all over the world every day. Hence, using various triage scales to detect sick patients and the need for early admission are essential. Triage is a process used in the ED to prioritize patients requiring the most urgent care over those with minor injuries based on medical urgency and medical needs. These decisions may be based on patients’ chief complaints at the time of their ED visit and their vital signs. Vital signs, including blood pressure (BP), respiratory rate (RR), heart rate (HR), and body temperature, are necessary tools that are traditionally used in the ED during procedures such as triage and recognizing high-risk hospital inpatients. This study aimed to determine the relationship between abnormal vital signs and mortality in the ED.Method and MaterialThis retrospective record review study was performed at the ED of King Abdulaziz University Hospital (KAUH). Altogether, 641 patients fulfilled our inclusion criteria. Data including patients’ demographics, vital signs, in-hospital mortality, triage level, and precipitating factors were collected.ResultsThe mean age of the patients was 45.66 ± 18.43 years (69.3% females), and the majority of them had Canadian Triage and Acuity Scale (CTAS) level 3 (71.1%). The total number of in-hospital mortalities was 32 (5%). Lower systolic blood pressure (SBP) and diastolic blood pressure (DBP), high respiratory rates, and low oxygen saturation (O2SAT) were significantly associated with high mortality rates.ConclusionAbnormal vital signs play a major role in determining patient prognosis and outcomes. Triage score systems should be adjusted and carefully studied in each center according to its population.

We evaluated the validity of the Canadian Paediatric Triage and Acuity Scale (PaedCTAS) for children visiting a pediatric emergency department (ED). This was a retrospective study evaluating all children who presented to a pediatric university-affiliated ED during a 1-year period. Data were retrieved from the ED database. Information regarding triage and disposition was registered in an ED database by a clerk following patient management. In the absence of a gold standard for triage, admission to hospital, admission to pediatric intensive care unit (PICU) and length of stay (LOS) in the ED were used as surrogate markers of severity. The primary outcome measure was the correlation between triage level (from 1 to 5) and admission to hospital. The correlation between triage level and dichotomous outcomes was evaluated by a chi2 test and an analysis of variance (ANOVA) was used to evaluate the association between triage level and ED LOS. Over the 1-year period, 58,529 patients were triaged in the ED. The proportion admitted to hospital was 63% for resuscitation (level 1), 37% for emergent (level 2), 14% for urgent (level 3), 2% for semiurgent (level 4) and 1% for nonurgent (level 5) (p < 0.001). There was also a good correlation between triage levels and LOS and admission to PICU (both p < 0.001). This computerized version of PaedCTAS demonstrates a string association with admission to hospital, admission to PICU and LOS in the ED. These results suggest that PaedCTAS is a valid tool for triage of children in a pediatric ED.

Predicting Pediatric Emergency Severity Index Level Based on Emergency Department Pre-Arrival Information

Aim: To evaluate the effects of change of ambient temperature on emergency department (ED) patient visits. Methods: This prospective observational study was conducted in the ED of National Taiwan University...

BackgroundEmergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city.MethodsThis cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity.ResultsIn the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity.ConclusionIf the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.