Accident Department Research Articles

The Impact of the COVID-19 Pandemic and Socioeconomic Deprivation on Admissions to the Emergency Department for Psychiatric Illness: An Observational Study in a Province of Southern Italy.

The restriction measures adopted to limit population movement in order to contain the COVID-19 pandemic contributed to a global public health system crisis. This retrospective study aimed at identifying changes in psychiatric admissions to Accident and Emergency Departments (A&Es) in a province in southern Italy during the first two years of the pandemic and was characterized by two different restriction levels (phases 2 and 3) compared to the pre-pandemic period (phase 1). We also investigated the role of socioeconomic deprivation (DI) on psychiatric admissions. The total number of patients admitted to the A&Es was 291,310. The incidence of admission for a psychiatric disorder (IPd) was 4.9 per 1000 admissions, with a significant younger median age of 42 [IQR 33-56] compared to non-psychiatric patients (54 [35-73]). The type of admission and type of discharge were factors related to the psychiatric admission to A&E, and their relationship was modified by the pandemic. In the first year of the pandemic, patients with psychomotor agitation increased compared to the pre-pandemic period (72.5% vs. 62.3%). In the period preceding the spread of SARS-CoV-2, the IPd was equal to 3.33 ± 0.19; after the pandemic started, there was an increase in the IPd: 4.74 ± 0.32 for phase 2 and 3.68 ± 0.25 for phase 3. The IPd was higher for psychiatric admissions from areas with a very low DI compared to areas with a low DI; however, during phase 2, this difference was reduced. In conclusion, an increase in admissions for psychiatric disease was observed during the initial spread of SARS-CoV-2. Patients who lived in the most deprived municipalities generally came to the A&Es less than others, probably because the patients and their families had less awareness of their mental health. Therefore, public health policies to address these issues are needed to reduce the pandemic's impact on these conditions.

408 Knowledge and Attitudes of Health Care Professionals in the Intensive Care Unit (ICU), Haemodialysis Unit (HDU), and Accident and Emergency Department (A&E) at a Teaching Hospital Toward Organ (Kidney) Donation and Transplantation

408 Knowledge and Attitudes of Health Care Professionals in the Intensive Care Unit (ICU), Haemodialysis Unit (HDU), and Accident and Emergency Department (A&E) at a Teaching Hospital Toward Organ (Kidney) Donation and Transplantation

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan.

The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT. This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes. In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001). Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT.

Acute Stanford Type A Aortic Dissection: A Review of Risk Factors and Outcomes.

Acute aortic dissection (AAD) can be said to be a relatively uncommon emergency with fatal outcomes mainly due to delayed/missed diagnosis and treatment. Its ability to masquerade as other emergencies like acute coronary syndrome and pulmonary embolism makes the prognosis unfavorable in a significant proportion of patients. Patients have been seen to present to the accident and emergency department or outpatient setting with typical or atypical symptoms as we will discuss in this article. We have focused on indicators for risk and prognosis of acute Stanford type A aortic dissection in this traditional review. It is well known that despite recent developments and improvements in treatment modalities, AAD is still associated with a significant mortality rate and postoperative complications.

HIV-1/2 prevalence among patients attending the Accident and Emergency Clinic in Southwest Nigeria.

The Human Immunodeficiency Virus (HIV) pandemic is without a doubt one of the most significant public health disasters of our day. It is a complex mashup of various epidemics that have spread inside and between different nations and areas of the world. Patients, who had retroviral screening in the Accident and Emergency Department of University College Hospital, Ibadan, were included in this retrospective analysis. In total, 2,321 patients were screened over the course of a year, and 83 (3.6%) of those had positive HIV-1/2 quick diagnostic test results using the Determine HIV-1/2, Uni-Gold HIV-1/2, and Stak-pak HIV-1/2 rapid diagnostic kits. A total of 1,248 (53.8%) males and 1,073 (46.2%) females were tested the positive values for men and women, respectively, were 42 (50.6%) and 41 (49.4%) (P = 0.921).

Anticoagulant rodenticide ingestion: Who will develop coagulopathy?

Introduction:Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion.Methods:This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above.Results:One hundred sixty‐nine patients were included in the final analysis. The median age was 44 years old. Forty‐nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p &lt; 0.05) showed that age (p = 0.003), ingestion of first‐generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p &lt; 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p &lt; 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co‐ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p &lt; 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first‐generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p &lt; 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis.Conclusion:Ingestion of more than one pack and ingestion of first‐generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.

Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Study (NEDOCS) in Tertiary Care Hospital to Measure Emergency Department Crowding

Objective: To compare NEDOCS with ICMED in predicting clinicians' concerns regarding crowding in the Emergency Department of a tertiary care hospital in Pakistan.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Accident &amp; Emergency Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Jan 2022.&#x0D; Methodology: This study was conducted at the Accident and Emergency Department over 14 different days, 30 data sets of 3-hour intervals each were collected using the NEDOCS and ICMED proforma. NEDOCS Scores and ICMED scores were calculated. In addition, perceptions of the staff regarding crowding and danger to the patient's status were recorded on Visual Analogue scales.&#x0D; Results: The mean recorded NEDOCS score was 577.94±251.57, with 29 'extremely overcrowded' and 1 'overcrowded' data set.The mean ICMED score was 2.86±0.83. Twenty-four (80%) sets did not have crowding, with only six (20%) sets being categorized as 'crowded'. The NEDOCS score had a moderately positive correlation with the crowding perception of the staff (Correlation coefficient (r)=0.593).&#x0D; Conclusion: NEDOCS was a more suitable measure for recording ED crowding in Pakistan, as it recorded the quantitative component of waiting time. ICMED, on the other hand, only recorded waiting time on a binary scale, with the waiting time impact not translated fully on the total score.

Pediatric Injury Patterns Presenting at a Tertiary Care Hospital Emergency Department

Introduction: Injuries in the pediatric population relate to significant liability, especially in low- and middle-income countries.1 The aim of this study is to decipher the patterns of pediatric injury in Pakistan. This may give the data on the pattern of pediatric injuries, thereby strategies could be made to deal such patients and eventually reduce the mortalities and morbidities. Objective: To evaluate pediatric injury patterns presenting in emergency department of Liaquat National Hospital, Karachi. Methodology: The study was held at the Emergency department of LNH for six months from 11th may 2018 to 11th November 2018. It was a cross sectional study. Ninety children suffering from trauma as per their history were included in this study. Demographics were noted of all the patients enrolled in the study. An approved Performa was used for recording the outcome variables . Results: - The median age of the children was 4.81±3.12 years. Out of 90 children, 71(79%) were boys and 19(21%) were girls. Pattern of injury were included road traffic injuries (54.4%),falls from height (31.1%), poisoning (9%) ,burns (3.3%) and electrocution (2.2%) Conclusion: We conclude that the patterns of pediatric injuries in children presenting in accident and emergency department shows road traffic accidents as the leading cause followed by fall from height, poisoning and burns. The study emphasizes the need to build an injury surveillance in the emergency dept that would be a building block for a national injury surveillance database. Along with it, study highlights necessary injury prevention measures that would assist in addressing preventable childhood injuries in Pakistan . Keywords: Pediatric injuries, Road traffic injuries, Poisoning

SURGICAL HOT TELEPHONE CLINIC: A SAFE ALTERNATIVE TO FACE-TO-FACE HOT CLINIC

Introduction: With increasing patients presenting to the accident and emergency department, the use of virtual clinics has shown promising results in medicine to help safely review these patients while avoiding admissions. These clinics often use the same staff and resources being utilised by theemergencyadmission team – this is especially true in the surgical admissions unit. We present data showing that Virtual Clinics (VC) are safe alternatives, improving patient service and relieving a significant burden on the acute surgical units. Method: Baseline assessment of the virtual clinic was carried out over a 4-week period, between 23rd December 2020 and 19th January 2021. The virtual clinic reviewed 78 patients within this 4-week time period. Parameters for data collection included admission dates, scan date, call-backs, diagnosis, referral patterns, readmission rates and eventual outcomes for those who needed surgical interventions. Reassessment of practise was undertaken in August 2021 following the introduction of a registrar led electronic virtual clinic. Results: Assessment of practice showed that 83% of assessed patients had radiological imaging within 72hours with 89.7% of these scans having reports generated on the same day. Following incorporation of an electronic virtual clinic, 112 patients were reviewed over a 4-week period. Results showed a similar trend in terms of frequency of scans requested with zero failed discharges from the service. Conclusion: The virtual clinic provides a safe and efficient method for the review and management of ambulatory patients in whom semi- urgent investigation is needed but admission is not necessary.

Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study.

Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.

HIV self-testing acceptability among injured persons seeking emergency care in Nairobi, Kenya

ABSTRACT Background Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. Objectives This study sought to understand the injury patient acceptability of ED-HIVST. Methods Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. Results Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they ‘Agree Completely’ with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36–2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27–2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72–4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41–2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01–2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38–2.33) had greater odds of agreeing completely. Conclusions ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya.

A comparison of synthetic control approaches for the evaluation of policy interventions using observational data: Evaluating the impact of redesigning urgent and emergency care in Northumberland.

To compare the original synthetic control (OSC) method with alternative approaches (Generalized [GSC], Micro [MSC], and Bayesian [BSC] synthetic control methods) and re-evaluate the impact of a significant restructuring of urgent and emergency care in Northeast England, which included the opening of the UK's first purpose-built specialist emergency care hospital. Simulations and data from Secondary Uses Service data, a single comprehensive repository for patient-level health care data in England. Hospital use of individuals exposed and unexposed to the restructuring is compared. We estimate the impact using OSC, MSC, BSC, and GSC applied at the general practice level. We contrast the estimation methods' performance in a Monte Carlo simulation study. Hospital activity data from Secondary Uses Service for patients aged over 18 years registered at a general practice in England from April 2011 to March 2019. None of the methods dominated all simulation scenarios. GSC was generally preferred. In contrast to an earlier evaluation that used OSC, GSC reported a smaller impact of the opening of the hospital on Accident and Emergency (A&E) department (also known as emergency department or casualty) visits and no evidence for any impact on the proportion of A&E patients seen within 4 h. The simulation study highlights cases where the considered methods may lead to biased estimates in health policy evaluations. GSC was found to be the most reliable method of those considered. Considering more disaggregated data over a longer time span and applying GSC indicates that the specialist emergency care hospitals in Northumbria had less impact on A&E visits and waiting times than suggested by the original evaluation which applied OSC to more aggregated data.

Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study.

Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.

Knowledge and attitudes of nurses towards pain management at Edward Francis Small Teaching Hospital, Banjul

BackgroundPain is known to affect a person’s physical, mental health, and quality of life. Therefore, its management and control is a very important goal in patient care. Inability to adequately assess, manage patients’ pain and intervene accordingly has an impact on patients’ quality of life. AimTo investigate the knowledge and attitude of nurses towards pain management at the Edward Francis Small Teaching Hospital (EFSTH), in The Gambia. MethodsDescriptive cross-sectional study design was used. A sample of 115 nurses was recruited using the convenience sampling method. Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to assess the knowledge and attitude of pain among nurses. Cronbach’s alpha coefficient for this instrument was 0.73. Data were analyzed using the Statistical Package for the Social Sciences software (SPSS, version 20). Descriptive statistics, chi-squared test, and regression analysis were used to analyse the data using SPSS version 20.0. Approval for the study was granted by the EFSTH Research Review Board. ResultsOne hundred and fifteen nurses filled and returned the questionnaire giving a response rate of 79 %. The mean age of study participants was 29.39 years (SD ± 6.3) and years of working experience was 5.17 years (SD ± 5.0). The mean total score of the NKASRP was 50.0 (SD ± 12.3). The majority of the nurses had inadequate knowledge (60.9 %) and an unfavorable attitude (69.6 %) towards pain management. Logistic regression analysis showed nurses working in the accident & emergency department are more likely to have adequate knowledge (p < 0.05), and BSc degree nurses are more likely to have a favorable attitude towards pain management (p < 0.05). ConclusionNurses have inadequate knowledge and unfavorable attitude towards pain management and this continues to be a challenge in health care facilities in The Gambia. Therefore, regular in-service training, extra workshops, and seminars both for students and staff nurses are recommended.

Implementing dialectical behaviour therapy in routine practice: an evaluation of a national CAMHS DBT service for adolescents

Abstract Self-harming behaviours are reported to be increasing amongst young people and are associated with increased risk of suicide. The recently published UK clinical guidelines highlight that cross-sector awareness and early psychosocial assessment of self-harming is necessary, alongside careful triaging as to the level of support required. Dialectical behaviour therapy for adolescents (DBT-A) is a recommended intervention for young people with more severe difficulties. The current study aims to contribute to the data available to inform ongoing clinical decisions about the feasibility and implementation of DBT-A by reporting the intervention method, participant characteristics, and clinical outcomes of a national (UK) DBT service for young people with high levels of need and risk. Young people who commenced treatment between 2015 and 2021 were included. Completion rates, reasons for non-completion, and discharge pathways are reported. Measurement and changes in outcomes, including self-harm, in-patient bed days, accident and emergency department attendances and education/work status, are reported, as well as for routine outcome measures assessing emotion dysregulation and symptoms of emerging borderline personality disorder, depression and anxiety. The clinical significance of these outcomes are considered. Ideas for service evaluation, which are feasible and replicable in busy clinical settings are proposed, as well as a discussion of potential adaptations to standardised protocols needed in this context to fit with National Health Service (NHS) resources and the needs of the target population. Key learning aims (1) To learn about the implementation of dialectical behaviour therapy (DBT) and concurrent outcome monitoring in a UK National Health Service CAMHS out-patient setting. (2) To understand the clinical profile and response to treatment of young people with high levels of suicidal and non-suicidal self-harming behaviours. (3) To present a potential method for outcome monitoring and collection for CAMHS DBT services.

Deadly suicidal attempt and burdensome airway management, challenges to anesthesiologist with exposed airway

Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.

Reasons for Avoiding their Local Clinics among Non-emergency Patients at Accident and Emergency Department, Pretoria, South Africa

Background: An accident and emergency department (AED) is designated for patients who need to be seen urgently. However, at Jubilee Hospital, a large number of patients regularly presented directly to the AED with minor ailments. This resulted in long queues in the already overcrowded waiting room. Methods: A cross-sectional study design with a sample of 289 participants. Results: Those aged 21-40 years accounted for 44.6% of the participants. Patients mainly arrived on Fridays (72%), and medical-related complaints (128; 44.3%) were the most prevalent. In addition, patients primarily relied on public transportation to get there (180; 62.1%). In most cases, patients had previously visited clinics more than twice (141; 58.8%). Majority of patients were aware of the community health centres’ services. Only 33.6% of the clinics that were bypassed provided services 24 hours a day. Almost 80% of bypassed clinics were within 10 km of the District Hospital. Patients’ main reasons were long queues (89.6%) and medication shortages (67.6%). In 51.2% of cases, patients were aware of the referral system, but 14.5% did not think it made sense, and 11% did not understand it well. Conclusion: Proper strict application of the triage system and education of patients will decrease emergency department overcrowding. This will improve patient safety, clinical outcomes and the efficiency of the health system. In addition, changing local clinics’ operating hours will assist in reducing the high number of patients seen at Jubilee Hospital.

LISTERIA MONOCYTOGENES, A CASE OF MISTAKEN IDENTITY

A 74 years old female patient who was a known case of Diabetes Mellitus, Hypertension, and Breast Cancer presented in the Accident and Emergency Department with complaints of fever, seizures, and an altered state of consciousness. The patient was febrile with a temperature of 40° C, blood pressure was 140/80 mmHg, and pulse was 90 beats/min. She was in an altered state of consciousness with a Glasgow Coma Scale score of 10/15. The rest of the physical examination was unremarkable. The pleomorphic nature of this bacterium and clinical presentation similar to meningitis caused by other micro-organisms make the laboratory and clinical diagnosis respectively rather difficult. We illustrate the clinical presentation, antibiotic therapy, and laboratory diagnosis of L.monocytogenes in a patient with weak immune status. A high clinical suspicion of Listeriosis is essential for prompt and accurate treatment if a case of meningitis is not responding to traditional empirical antibiotics, and especially in immunocompromised.

SPATIAL DESIGN EVALUATION OF ACCIDENT AND EMERGENCY DEPARTMENT OPTIMIZATION: A CASE OF CAPITAL HOSPITAL G-6, ISLAMABAD

Sustainable usage and optimal performance of Accident and Emergency (A &amp; E) department of any hospital is one of the most critical need of healthcare infrastructure in times of trauma, catastrophes and emergencies. Exploration with respect to A&amp;E optimization is missing in the context of Pakistan. A study was undertaken with the focus on A&amp;E Department at Capital hospital, Islamabad. Based on standards of A&amp;E design optimization, a checklist based observational study was followed using the data obtained from the respondents from medical, paramedic, support and administrative staff along with patients and their attendants. It was concluded that the existing facility fails to fulfill the requirements for a standardized A&amp;E Department for targeted number of beds and hence needs design interventions. The researchers with the help of A&amp;E lead and chief medical officer devised a facility brief and later proposed a whole new design facility in the current context for sustainable usage in the future. Keywords: Healthcare design, Environmental design, Accident and emergency, Architectural intervention, Sustainable usage

Introduction of the Discharge Medicines Service (DMS) at acute NHS trust, does this go far enough?

Abstract Introduction The Discharge Medicines Service (DMS) is one of several initiatives being implemented as part of the NHS 5-year plan's second year to relieve the load on hospital Accident and Emergency (A&amp;E) departments. The DMS service specification states that patients who are considered to be at risk of medication-related harm should be electronically referred by the NHS Trust to a pharmacy for assistance with their medications within 24-48 hours of being discharged from the hospital. NHS England and NHS Improvement made available £1.2 million to ensure NHS trusts have appropriate software and functionality to send referrals to community pharmacy, but the funding is not available to private providers responsible for community hospital services. However, for the DMS service to strengthen and improve medicine safety across the NHS, there is a need to involve community hospital services run by private providers. Aim The aim of this study was to investigate the medicines related risk for patients discharged from Caterham Dene Hospital (CDH), a community hospital service. Methods A retrospective analysis of patient discharge summaries was carried out to determine whether there were changes in the patient’s medication prior to being discharged from East Surrey Hospital (ESH) to CDH and then to their home. The medical records of (N=183) patients who were admitted to CDH from ESH between 1st June 2021 - 31st December 2021 were identified. 22 patients who were re-admitted to ESH through A&amp;E and 2 patients whose discharge letter could not be found in their medical record or had missing information were excluded. Patients who were discharged to another care setting, e.g. a care home, were also excluded from this study. A data collection form was used, and the data were transferred to Microsoft Excel for descriptive statistical analysis. As a service evaluation, ethical approval was not required. Results A total of 159 patients’ medical records and discharge summaries were analysed, of whom 97% of patients had changes in their medication after admission to CDH. The most frequent changes were either having medication stopped because it was no longer required, or medication started due to new diagnosis. The top two commonly identified drug classes are laxatives and opioids. 40% of all medicines that were changed were appropriate for DMS referral on discharge from CDH. Discussion/Conclusion Although a small-scale study, the findings demonstrate that it is important for private providers of community hospital services, such as First Community, to be included to deliver the DMS referral service. Further investigation is recommended to explore whether similar results would be achieved in other community hospital services run by private providers. In response to the discharge data shared, Surrey Heartland Integrated Care System made available funds to roll out the DMS service to CDH. First Community is the only private provider currently delivering the DMS service and between mid-June and July 2022 a total of 10 patients have been referred.