Critical Emergency Department Patients Research Articles

Psychological Distress and the Needs of Family Members of Critically Ill Patients in Emergency Departments During the COVID-19 Pandemic: A Cross-Sectional Study

IntroductionThe literature highlights the importance of the needs of family members of critical patients in emergency departments. Understanding these needs helps to alleviate psychological distress and contribute to the patients’ recoveries. This study aimed to examine the psychological distress and needs of family members of critical patients in emergency departments. MethodsA cross-sectional design was used to collect data using the Depression, Anxiety, and Stress Scale-21, the Critical Care Family Needs Inventory for the Emergency Department, and the Needs Met Inventory questionnaire from a convenience sample of 170 family members of critical patients. Descriptive analysis and importance-performance analysis were applied to analyze the data. ResultsThe results showed that 52.4% of family members reported mild to extremely severe levels of depression, 60% reported mild to extremely severe levels of anxiety, and 53.5% had mild to extremely severe levels of stress. Anxiety showed a significant negative correlation with comfort needs (r = −0.17) and support needs being met (r = −0.16). The importance-performance analysis showed that the coordinates for support needs were in quadrant IV, signifying a higher level of importance perceived by family members but a lower level of the needs being met. ConclusionProviding the assessment and necessary support to alleviate psychological distress will help enhance the ability of the emergency department to meet families’ needs.

Application of Joanna Briggs Institute physical restraint standards to critical emergency department patients following CONSORT guidelines.

To explore the effect of Joanna Briggs Institute (JBI) physical restraint standards in improving physical restraint in critical and emergency department patients.Enrolled 300 critical patients admitted in our hospital's emergency department from January to December 2019: 150 patients admitted January to June 2019 as control group and 150 patients admitted July to December 2019 as observation group. Routine restraints were applied in control group. Emergency department nurses in the observation group received thematic and practical JBI standardized training. This included pre-restraint assessment, principles of physical restraint, informed consent, using a restraint decision-making wheel, and alternatives to physical restraint. The incidence of restraint-associated adverse events (e.g., skin bruising, swelling) and restraint utilization rate were examined between 2 groups.The incidence of adverse events and the restraint utilization rate were significantly lower in the observation group (P < .05).The application of JBI physical restraint standards for emergency department patients can effectively reduce the incidence of adverse events and the restraint utilization rate.

Using machine learning tools to predict outcomes for emergency department intensive care unit patients

The number of critically ill patients has increased globally along with the rise in emergency visits. Mortality prediction for critical patients is vital for emergency care, which affects the distribution of emergency resources. Traditional scoring systems are designed for all emergency patients using a classic mathematical method, but risk factors in critically ill patients have complex interactions, so traditional scoring cannot as readily apply to them. As an accurate model for predicting the mortality of emergency department critically ill patients is lacking, this study’s objective was to develop a scoring system using machine learning optimized for the unique case of critical patients in emergency departments. We conducted a retrospective cohort study in a tertiary medical center in Beijing, China. Patients over 16 years old were included if they were alive when they entered the emergency department intensive care unit system from February 2015 and December 2015. Mortality up to 7 days after admission into the emergency department was considered as the primary outcome, and 1624 cases were included to derive the models. Prospective factors included previous diseases, physiologic parameters, and laboratory results. Several machine learning tools were built for 7-day mortality using these factors, for which their predictive accuracy (sensitivity and specificity) was evaluated by area under the curve (AUC). The AUCs were 0.794, 0.840, 0.849 and 0.822 respectively, for the SVM, GBDT, XGBoost and logistic regression model. In comparison with the SAPS 3 model (AUC = 0.826), the discriminatory capability of the newer machine learning methods, XGBoost in particular, is demonstrated to be more reliable for predicting outcomes for emergency department intensive care unit patients.

Comparison of Reliability and Validity of the Chinese Four-Level and Three-District Triage Standard and the Australasian Triage Scale.

Emergency triage is an important tool for prioritizing urgent or critical patients, and its effect needs to be investigated and evaluated. This observational study aimed to compare the reliability and validity of the Chinese four-level and three-district triage standard (CHT) and the Australasian Triage Scale (ATS) in an adult emergency department of a general hospital in China. From 2016-01 to 2017-01, twelve nurses independently performed on-site triage of 254 patients and 1552 patients to assess the scales' reliability and validity, respectively. The interrater reliability, as assessed by the weighted k scores, was 0.686 (95% CI 0.608–0.757) for the CHT and 0.731 (95% CI 0.663–0.790) for the ATS, and the k scores between the CHT and the ATS were 0.630 (95% CI 0.594–0.669). Temperature, respiration, pulse, blood oxygen saturation, waiting time, treatment time, emergency disposition, hospitalization rate, and mortality were significantly associated with the triage levels of the CHT and ATS (p < 0.001). The area under the receiver operating characteristic (AUROC) curve values of the CHT and ATS for predicting intensive care treatment were 0.845 (95% CI: 0.825–0.866) and 0.740 (95% CI: 0.715–0.765), respectively. The reliability and validity of the CHT and ATS were moderate, and both of them can be used to identify critical patients in emergency departments. It is necessary to further improve the triage system in terms of structure and content.

Accuracy of bedside point of care testing in critical emergency department patients

BackgroundPoint-of-care (POC) testing reduces laboratory turn-around having the potential to improve timely diagnosis and management. We compared the accuracy of nurse performed POC and core laboratory testing and determined whether deviations between the two were clinically meaningful. MethodsWe performed a prospective, observational study on a convenience sample of 50 critical care ED patients in whom a POC chemistry and hematocrit was ordered. Blood samples were divided into 2 aliquots; one sample was tested by the treating nurse using a handheld POC device and the other sample was tested in the core laboratory. Paired comparisons of test results were performed using Pearson's correlation coefficients, Lin concordance coefficients, and Bland Altman plots. ResultsMean patient age was 67, 50% were male, 82% were admitted. Pearson's correlation and Lin concordance coefficients were excellent (0.84–1.00) for all 8 analytes. Mean (95%CI) paired differences between POC and core laboratory measurements were Na+ 0.30 (−0.22 to 0.82) mmol/L, K+−0.12 (−0.14 to - 0.09) mmol/L, Cl− 2.10 (1.41 to 2.78) mmol/L, TCO2–1.68 (−2.06 to −1.30) mmol/L, glucose 2.46 (1.46 to 3.46) mg/dL, BUN, 1.69 (0.95 to 2.42) mg/dL, creatinine 0.13 (0.08 to 0.17) mg/dL, and hematocrit −0.39 (−0.93 to 0.15) %. In 3 of 400 measurements, the difference between POC and core lab exceeded the maximal clinically acceptable deviation based on physician surveys. ConclusionsBedside POC by ED nurses is reliable and accurate and does not deviate significantly from core laboratory testing by trained technicians.

Comprehensive bedside point of care testing in critical ED patients: a before and after study

ObjectiveWe determined the effects of comprehensive point-of-care testing (POCT) on process of care in critically ill emergency department (ED) patients. We hypothesized that POCT would shorten ED length of stay (LOS), reduce time to test results, and reduce time to completion of intravenous (IV) contrast computed tomography (CT) imaging compared with central lab testing. MethodsA before and after study was performed in ED patients triaged to the critical care area. During the before period, traditional lab testing was performed, whereas in the after period, bedside POCT devices were introduced in all 15 critical care beds with 5 testing cartridges (chemistry with hemoglobin and hematocrit, troponin I, brain natriuretic peptide, lactate, and international normalized ratio [INR]). Clinical protocols indicated when POCT should be used. ResultsThe numbers of critical ED patients before and after introducing POCT were 1405 and 981 respectively. Test turnaround (minutes) was significantly reduced with bedside POCT for all five tests. Use of POCT reduced the median [interquartile range] time to completion of IV contrast CT by 81 minutes (96 [55-214] vs 177 [78-300]; P = .004). Point-of-care testing significantly reduced median ED LOS in patients who received an IV contrast CT (260 [180-410] vs 347 [347 (202-523]; P = .03). ConclusionsIntroduction of comprehensive bedside POCT in critical ED patients is associated with significant reductions in test turnaround, and time to completion of CT scanning when IV contrast is required. ED LOS was also reduced in the latter population.

In reply

Academic Emergency MedicineVolume 13, Issue 5 p. 586-587 Free Access In reply Marc Martel MD, Marc Martel MD (marc.martel@co.hennepin.mn.us) Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorAnn Sterzinger MD, Ann Sterzinger MD Health East Hospitals, St. Paul, MNSearch for more papers by this authorJames Miner MD, James Miner MD Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorJoseph Clinton MD, Joseph Clinton MD Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorMichelle Biros MD, MS, Michelle Biros MD, MS Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this author Marc Martel MD, Marc Martel MD (marc.martel@co.hennepin.mn.us) Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorAnn Sterzinger MD, Ann Sterzinger MD Health East Hospitals, St. Paul, MNSearch for more papers by this authorJames Miner MD, James Miner MD Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorJoseph Clinton MD, Joseph Clinton MD Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this authorMichelle Biros MD, MS, Michelle Biros MD, MS Hennepin County Medical Center and University of Minnesota, Minneapolis, MNSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2005.12.008AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References Martel M, Miner J Lashkowitz S, et al. QT prolongation and cardiac arrhythmias associated with droperidol use in critical emergency department patients [abstract]. Acad Emerg Med. 2003; 10: 510b– 1b. Smith S, Martel M Chase P, et al. QT prolongation after the administration of droperidol [abstract]. Acad Emerg Med. 2002; 9: 374a– 5a. Martel M, Leuck K Miner J, et al. Complications and QT prolongation associated with droperidol use in non-critical emergency department patients [abstract]. Ann Emerg Med. 2003; 10: s100– 1. Chase PB, Biros MH. A retrospective review of the use and safety of droperidol in a large, high-risk, inner-city emergency department patient population. Acad Emerg Med. 2002; 9: 1402– 10. Martel M, Miner J Fringer R, et al. Discontinuation of droperidol for the control of acutely agitated out of hospital patients. Prehosp Emerg Care. 2005; 9: 44– 8. MedWatch 2001 Safety Information Summaries: Inapsine (Droperidol). Available at: http:www.fda.govmedwatchSAFETY2001inapsin.htm. Accessed Mar 14, 2006. Stratton SJ, Rogers C Green K. Sudden death in individuals in hobble restraints during paramedic transport. Ann Emerg Med. 1995; 25: 710– 2. Reay DR, Flinger Cl Stiwell AD, et al. Positional asphyxia during law enforcement transport. Am J Forensic Med Pathol. 1992; 13: 90– 7. Hick JL, Smith SW Lynch MT. Metabolic acidosis in restraint associated cardiac arrest: A case series. J Emerg Med. 1999; 6: 239– 44. Volume13, Issue5May 2006Pages 586-587 ReferencesRelatedInformation

QT Prolongation and Cardiac Arrhythmias Associated with Droperidol Use in Critical Emergency Department Patients

QT Prolongation and Cardiac Arrhythmias Associated with Droperidol Use in Critical Emergency Department Patients

Emergency noninvasive external cardiac pacing

Thirty-seven critical emergency department patients underwent attempts at external cardiac pacing over an 11-month period. Indications for pacing were asystole in 16, complete heart block (CHB) in 4, sinus bradycardia in 2, nodal bradycardia in 1, atrial fibrillation with bradycardia in 2, electromechanical dissociation in 1, idioventricular rhythm (IVR) in 10, and torsades de pointes in 1. Eight patients were successfully paced with improvement in their condition. Two were in asystole, two in CHB, three in sinus rhythm or atrial fibrillation with bradycardia, and one in idioventricular rhythm. Mean systolic blood pressure rise with pacing was 95 ± 50 mm Hg. Six of these patients were ultimately discharged from the hospital. One asystolic patient survived to discharge. Other survivors presented with either CHB or bradycardia. Of the 29 patients who did not respond to pacing, 5 survived to hospital discharge. Surviving nonresponder presenting rhythms were CHB in one patient, sinus or nodal bradycardia in two, IVR in one, and torsades de pointes in one. External cardiac pacemaking appears to be effective in hemodynamically significant bradycardia. It does not appear to be effective in most instances of asystole or IVR resulting from prolonged cardiac arrest. When applied to patients with a responsive myocardium, it may result in significant hemodynamic improvement and may be lifesaving.