Electronic Log Research Articles

Women Supervised Under Professional Methadone Programs Show Comparable Pregnancy Outcomes to Non-Methadone Users [14L

INTRODUCTION: The purpose of this study was to evaluate the outcomes of women treated under methadone maintenance programs versus those with cocaine or heroin use during pregnancy compared to non-drug users. METHODS: Retrospective review of deliveries at Winnie Palmer Hospital (WPH) between 1/1/2010 to 9/1/2013 (N=34,483). Data regarding methadone use was obtained from the WPH pharmacy and electronic labor and delivery log. Group 1 included 55 patients enrolled in professionally supervised methadone programs. Group 2 included 19 patients undergoing self treatment or not enrolled in a maintenance program but had positive cocaine on urine drug panel or admitted to heroin use during the pregnancy. Group 3 included 34,408 patients with no drug or methadone use in pregnancy. The stats included chi square, ANOVA and Mann Whitney U. SPSS analysis with P=<.05 for statistical significance. RESULTS: In group 1, significant differences were noted in BMI (29 vs 27), estimated gestational age at delivery (EGA) (38.4 vs 36.2) and preterm birth (15% vs 53%) when compared to the cocaine/heroine group. Other clinical variables noted to be different included Hepatitis C (16% vs 5%), birth weight (3037 g vs 2747 g) and NICU admissions (16% vs 26%). Similarities in the outcomes for methadone patients compared to group 3 could be seen in BMI, EGA and rate of repeat cesarean sections. CONCLUSION: Women in professionally supervised methadone programs have similar pregnancy outcomes in the tested variables as non-drug users. These favorable outcomes with methadone treatment in a professionally supervised program validate its use in pregnancy.

P093: The effect of Alberta’s new impaired driving legislation on motor vehicle-related trauma

Introduction: Motor vehicle collisions (MVCs) resulting in injuries and death disproportionately involve impaired drivers. Those under the influence of alcohol also have a much higher rate of presentation and admission to hospital for traumatic injuries. In an attempt to decrease impaired driving and consequently alcohol related MVCs and injuries, the government of Alberta recently introduced more strict legislation in the summer of 2012 for drivers found to be under the influence of alcohol. However, it has yet to be seen what impact the enforcement of this new legislation has had on traumatic injuries secondary to MVCs and alcohol impairment. The objective of this study was to assess the relationship between the implementation of Alberta’s new impaired driving legislation and the number of alcohol-related motor vehicle traumatic injuries presenting to the emergency department of a Level I Trauma Centre. Methods: A retrospective single centre cross-sectional chart review examining all adult patients presenting to the ED of a major trauma centre who: a) require trauma team activation or consultation and b) have a MVC related injury. Of those charts meeting these criteria, the proportion of patients with positive ethanol screens will be compared between the year before and after the new legislation being implemented. Patients will be identified using electronic medical record logs. Results: 938 total MVC related trauma patients were identified during the study period (468 prior to legislation enactment [2010-2012], 470 after [2012-2014]). 33.3% of these MVC trauma patients had positive ethanol screens prior to the legislation enactment and 32.4% after (a non significant decrease). Interestingly, with a secondary analysis on a year by year basis, the trends appear to be more noteworthy. When comparing between 2010 and 2013 there was a statistically significant drop in the number of cases over legal limit by 7.74%. Subgroup analysis also demonstrated a large, statistically significant drop in 16-24 yr old cases between 2010 and 2013, from 29 to 11% (a 62% drop). Conclusion: While an impact was not seen immediately following the enactment of Alberta’s new impaired driving legislation, a year by year analysis demonstrates a statistically significant decrease in MVC related trauma involving alcohol in the years following the new law. Of note, a substantial 62% drop was seen in the 16-24 year old age category.

Information security governance for e-services in southern African developing countries e-Government projects

Purpose – Highly sensitive information pertaining to citizens and government transactions is processed in an electronic format, making information security a critical part of e-Government applications and architectures. Information security measures should ideally span from authentication to authorisation and from logical/physical access control to auditing of electronic transactions and log books. The lack of such measures compromises confidentiality, integrity and availability of information. Today, most e-Government projects in developing countries in Southern Africa Developing Community (SADC) face challenges in two main areas, namely, information security and application software integration. This paper aims to discuss and analyse the information security requirements for e-Government projects and proposes an information security governance model for service-based architectures (SBAs). Design/methodology/approach – The current state of information security in emerging economies in SADC countries was researched. The main problems identified were the lack of software integration and information security governance, policy and administration. The design consists of three basic layers: information security governance defined at the strategic level of the government; information security policy/management defined at the management/operational level; and information security measures, implemented at the technical level. This section also proposes a policy for implementing public key infrastructures to protect information, transactions and e-services. A Token-Ring-based mechanism for implementing Single-Sign-On has also been developed as part of this study. Findings – The main problems identified were the lack of software integration and information security governance, policy and administration. These challenges are causing e-government projects to stagnate. Practical implications – The proposed approach for implementing information security in e-Government systems will ensure a holistic approach to ensuring confidentiality, integrity and non-repudiation, allowing e-Government maturity to progress from “interaction” to “online transaction” stage in emerging economies. Originality/value – Research has not focused on developing a solution for emerging economies which are facing difficulties in integration software applications to deploy end-to-end e-services and to produce an underlying identity management architecture and information security governance to secure the e-services developed and deployed using an SBA. The work produced in this paper is specific to SBAs in e-government environments where legacy systems already exist. The work includes: information security governance defined at the strategic level of the government; information security policy/management defined at the management/operational level; and information security measures implemented at the technical level. This section also proposes a policy for implementing public key infrastructures to protect information, transactions and e-services. A Token-Ring-based mechanism for implementing Single-Sign-On has also been developed as part of this study.

Foundations of Intervention Research in Instrumental Practice.

The goals of the present study are to evaluate, implement, and adapt psychological skills used in the realm of sports into music performance. This research project also aims to build foundations on how to implement future interventions to guide music students on how to optimize practice toward performance. A 2-month psychological skills intervention was provided to two students from the national music academy's bachelor program in music performance to better understand how to adapt and construct psychological skills training programs for performing music students. The program evaluated multiple intervention tools including the use of questionnaires, performance profiling, iPads, electronic practice logs, recording the perceived value of individual and combined work, as well as the effectiveness of different communication forms. Perceived effects of the intervention were collected through semi-structured interviews, observations, and logs.

The Use of Acceleration to Code for Animal Behaviours; A Case Study in Free-Ranging Eurasian Beavers Castor fiber.

Recent technological innovations have led to the development of miniature, accelerometer-containing electronic loggers which can be attached to free-living animals. Accelerometers provide information on both body posture and dynamism which can be used as descriptors to define behaviour. We deployed tri-axial accelerometer loggers on 12 free-ranging Eurasian beavers Castor fiber in the county of Telemark, Norway, and on four captive beavers (two Eurasian beavers and two North American beavers C. canadensis) to corroborate acceleration signals with observed behaviours. By using random forests for classifying behavioural patterns of beavers from accelerometry data, we were able to distinguish seven behaviours; standing, walking, swimming, feeding, grooming, diving and sleeping. We show how to apply the use of acceleration to determine behaviour, and emphasise the ease with which this non-invasive method can be implemented. Furthermore, we discuss the strengths and weaknesses of this, and the implementation of accelerometry on animals, illustrating limitations, suggestions and solutions. Ultimately, this approach may also serve as a template facilitating studies on other animals with similar locomotor modes and deliver new insights into hitherto unknown aspects of behavioural ecology.

Use of a web-based image reporting and tracking system for assessing abdominal imaging examination quality issues in a single practice.

This article presents our local experience in the implementation of a real-time web-based system for reporting and tracking quality issues relating to abdominal imaging examinations. This system allows radiologists to electronically submit examination quality issues during clinical readouts. The submitted information is e-mailed to a designate for the given modality for further follow-up; the designate may subsequently enter text describing their response or action taken, which is e-mailed back to the radiologist. Review of 558 entries over a 6-year period demonstrated documentation of a broad range of examination quality issues, including specific issues relating to protocol deviation, post-processing errors, positioning errors, artifacts, and IT concerns. The most common issues varied among US, CT, MRI, radiography, and fluoroscopy. In addition, the most common issues resulting in a patient recall for repeat imaging (generally related to protocol deviation in MRI and US) were identified. In addition to submitting quality problems, radiologists also commonly used the tool to provide recognition of a well-performed examination. An electronic log of actions taken in response to radiologists' submissions indicated that both positive and negative feedback were commonly communicated to the performing technologist. Information generated using the tool can be used to guide subsequent quality improvement initiatives within a practice, including continued protocol standardization as well as education of technologists in the optimization of abdominal imaging examinations.

Use of Electronic Loggers to Measure Changes in the Rates of Hand Washing with Soap in Low-Income Urban Households in India

We evaluated the utility of electronic loggers to measure the effects of a simple intervention designed to influence the rates of hand washing with soap within enclosed toilets and bathrooms in low-income urban households in Kerala, India. 58 households were given three items with embedded electronic loggers for a period of 2-5 days. Two logged soaps tracked hand and body washing in the bathroom. The third logged item was a water vessel used for flushing the toilet and for post-defecation anal cleansing; this served as a marker of toilet use. In addition, 28 households in a Soap by toilet arm were given an additional logged soap, to be kept by the toilet, and used for hand washing. Compared with the Soap in bathroom arm, the loggers in the Soap by toilet households recorded 73% greater daily use of soaps designated for hand washing (t(36)=2.92, p<0.01) and 172% greater use within 2 minutes of the use of the water vessel (t(36)=3.51, p = 0.001). We conclude that the loggers were capable of detecting changes in the rates of hand washing with soap and changes in hand washing with soap after use of the toilet. Further adoption of logger technologies would enable more insightful studies of hand washing within urban environments.

The innovation of an electronic teaching log: Recording and rewarding surgical trainees’ teaching experience

The innovation of an electronic teaching log: Recording and rewarding surgical trainees’ teaching experience

Work-related musculoskeletal disorders among Indian Physiotherapists

be gained. The document Clinical Education Guidelines for Canadian University Programs provides national guidelines for the expected clinical experience during physical therapy programs; unless the profile of student experience in the clinical setting is known, it is difficult to ensure that students have met these requirements. Methods: A PDSA (plan-do-study-act) model was utilized to introduce an electronic clinical log into the curriculum. The Planning phase included vendor selection and development of the software application. The “Do” phase included a pilot test; analysis of results from the pilot formed the “Study” phase which was followed by an initial “Act” phase consisting of modifications based on the results. Since full implementation, the PDSA cycle continues to be utilized to develop system enhancements and modifications based on feedback and user experience. Results:Design and redesign of the system required close and ongoing collaboration between educational institution, system vendor and end users (students). Data collected has included student experience with specific patient diagnoses, assessment and treatment skills utilized, level of independent practice, and a profile of clinical experience in the core areas of practice (such as cardiorespiratory). This information has been utilized by the educational program to encourage students to identify their individual learning gaps and needs, as well as to ensure congruence of individual and collective student experiencewith the clinical education guidelines. Unanticipated uses of the tool emerged including as a personal marketing strategy for students during job interviews and as a guide for developing student clinical learning objectives by clinical supervisors. Conclusion(s): The PDSA cycle provided an effective model for the development and implementation of a clinical logging tool for physical therapy students. Work is currently underway to explore the utility of the system for practicing physical therapists as part of a professional practice portfolio and as a tool to ensure continuing competence. Close collaboration between the vendor, institution and end users formed a key part of the success of the project. Implications: Use of the PDSA cycle can be an effective tool in guiding the process of development of development and implementation of an electronic clinical logging tool to ensure quality in the breadth and depth of clinical learning experiences during a physical therapy program.

Using Visual Analytics to Determine the Utilization of Preoperative Anesthesia Assessments.

Preoperative assessments are a required and essential element of anesthetic care, yet little is known about the utilization of these documents by clinicians who are not part of the anesthesia care team. As part of perioperative workflow restructuring, we implemented a data visualization technique of electronic medical record audit log data to understand the utilization of preoperative anesthesia assessments by non-anesthesia personnel. An audit log cache containing 140 days of data was queried for all accesses of preoperative anesthesia assessment documents for any patient who had a preoperative anesthesia assessment that was accessed during that period. User roles were aggregated into categories. Descriptive statistics and data visualization were generated using R (R Software Foundation, Vienna, Austria). Comparisons were performed with the Wilcoxon signed rank test with continuity correction. During the study period, 73 802 (0.015%) of the 485 062 902 audit log accesses were preoperative anesthesia assessments representing 412 departments, 302 user roles, and 3 916 distinct users who accessed preoperative anesthesia assessments from 14 235 surgical cases. Each assessment was accessed 2.9 times on average. Assessments performed in the preoperative anesthesia assessment clinic were accessed more frequently than those created on the day of surgery in the preoperative holding room (3.58 ± 5.18 v. 1.98 ± 1.76 average views; p<0.0001). We observed accesses of these documents by pathology and general surgery researchers, as well as orthopedics attending physicians accessing documents that were two years old. This approach revealed patterns of utilization that had not been previously identified, including usage by surgical residents, surgical faculty, and pathology researchers both before and after the surgical event for which the documents are generated. Knowledge of these dependencies directly informed perioperative workflow restructuring efforts. This visual analytic approach could be broadly utilized to understand documentation dependencies in a variety of clinical contexts.

ELUCIDATING DIGITAL INFORMATION AND WIRELESS COMMUNICATIONS TECHNOLOGY FOR AN ELECTRONIC WORKING LOGS AND APPLICATIONS

This work focuses on the troublesomeness of the traditional hardcopy working log sheets used in officers, proposing a Digital Information and Wireless Communications Technology based a Noble Design of Electronic Working Logs (EWL). This work also employs this dedicated tool to a real agent. There are some special features in this work: i) Easily operational interface, users can simply and instantly inquire the online request through the EWL; ii) Instantaneously monitor the situation, supervisors can clearly scrutinize the events; iii) Forever preservation, agent can conserve the electronic working logs endlessly due to the EWL. This work also implements the proposed EWL in a real officer agent and obtains some successful results.

Analysis of Opinion Evolution in a Multi-cultural Student Social Network

The spread of opinions in social networks is dependent on structural properties of the network and the individual characteristics of its nodes. To capture this dependence, several abstract models of such spread were proposed. First, we model the difference between the dynamics of opinion spread in communities with a static social network versus a dynamic social network. Here we use the theoretical model of spread of opinions called the Binary Agreement Model based on the naming game. Using this model, we study potential mechanisms for the dependencies observed in the data by matching model generated evolution of opinion with the empirically observed evolution in the data. Second, we examine the unique set of behavioral network data (based on electronic logs of dyadic contact via smartphones) collected at the University of Notre Dame. The participants are a sample of members of the entering class of freshmen in the fall of 2011 whose opinions on a wide variety of political and social issues have been regularly recorded—at the beginning and end of each semester—for the last three years. Using this data set, we measure the evolution of participants’ opinions and ascertain how much this evolution depends on the cultural traits of individuals and the structural properties of social networks that they form. Our analysis of our empirical dataset shows that ties among people who are more likely to share opinions (e.g. same race, gender, or socioeconomic class) decay at a slower rate than ties among persons who are likely to have different opinions. The analysis also indicates that the partner selection of individuals is associated sharing a (political) opinion. These results offer an assessment of the level of impact of culture and social network dynamics on the evolution of opinions in multi-cultural social networks.

Implementation of a Standard Interventional Radiology Signout as a Communication Quality Improvement Initiative

Purpose As the complexity and volume of cases performed in Interventional Radiology (IR) continues to grow, the need for improved communication between covering physicians, residents, and ancillary staff is critical to improve patient outcomes and minimize errors. The IR section underwent a quality improvement initiative implementing a standardized sign-out system consisting of an electronic tool and a formalized daily sign-out session. Education regarding appropriate sign-out was targeted to residents-in-training to address the growing complexity and volume within the department. The purpose of this project is to improve intra-department communication regarding the care and management of interventional radiology patients. Material and Methods A standardized electronic was created to assist with post procedural patient management. This was accessible to all interventional radiology attendings and radiology residents through a Health Insurance Portability and Accountability Act-compliant electronic database. A daily sign out session between IR staff and the on call resident was started. Baseline survey data (5-point Likert scale) was collected from the radiology residents regarding the initial informal sign-out system. The same survey was readministered 4 weeks after implementation. Results Data analysis was focused on resident responses, as they are most heavily involved in the signout process. This initial survey demonstrated that all radiology residents (n = 14) strongly agreed or agreed that an electronic accessible log of active IR cases would enable them to better answer questions, handle concerns about these cases on call, and improve patient safety. All residents strongly agreed or agreed that a digital, computer accessible log of active IR cases would allow for improved signout and communication regarding these patients. After 1 month of implementation of the new signout system, survey data demonstrated a positive trend in resident comfort handling phone calls and questions regarding IR cases while on call. In addition, the follow-up data demonstrated resident agreement that the new system allows for improved signout and communication and creates a stronger emphasis on patient safety. Conclusions There is critical need for continuous coverage and effective handoff in IR. Implementing a standardized signout helps IR physicians improve patient care and minimize hand off errors. This process also increases resident comfort in handing questions about IR patients and allows the residents to more effectively communicate with referring physicians about these patients. Based on our initial survey data, follow-up actions will include implementation of additional resident education to explain how to use the case database. A longer-term follow-up survey is needed to evaluate long-term results, as it will take many months for all of the residents to rotate through IR department and fully become acclimated to the new system.

Preparing students for class: How to get 80% of students reading the textbook before class

We discuss our implementation of targeted pre-reading assignments with an associated online quiz in two science classes, one physics and one biology. Our goal was to create a pre-class assignment that helped students recognize the benefits of reading before class. Students were asked to take part in a survey about how and why they completed the pre-reading assignments. We found that 80% of students read the textbook on a regular basis, which is much higher than reported in previous studies. Also nearly 3/4 of students reported using productive strategies for completing the reading assignment and cited reading prior to class as being helpful to their learning. Student self-reports were checked against electronic logs and were found to be highly accurate. Moreover, these results were nearly identical between the physics and biology courses.

The Fabric for Frontier Experiments Project at Fermilab

The FabrIc for Frontier Experiments (FIFE) project is a new, far-reaching initiative within the Fermilab Scientific Computing Division to drive the future of computing services for experiments at FNAL and elsewhere. It is a collaborative effort between computing professionals and experiment scientists to produce an end-to-end, fully integrated set of services for computing on the grid and clouds, managing data, accessing databases, and collaborating within experiments. FIFE includes 1) easy to use job submission services for processing physics tasks on the Open Science Grid and elsewhere; 2) an extensive data management system for managing local and remote caches, cataloging, querying, moving, and tracking the use of data; 3) custom and generic database applications for calibrations, beam information, and other purposes; 4) collaboration tools including an electronic log book, speakers bureau database, and experiment membership database. All of these aspects will be discussed in detail. FIFE sets the direction of computing at Fermilab experiments now and in the future, and therefore is a major driver in the design of computing services worldwide.

An observational, retrospective, UK and Ireland audit of patient adherence to subcutaneous interferon beta-1a injections using the RebiSmart(®) injection device.

BackgroundPoor adherence to disease-modifying drugs is associated with an increased risk of relapse in patients with multiple sclerosis. However, adherence is difficult to assess objectively. RebiSmart® (Merck Serono SA, Geneva, Switzerland), a device for subcutaneous (sc) injection of interferon (IFN) β-1a, features an electronic injection log that can assist in objective monitoring of adherence.ObjectiveTo assess adherence to sc IFN β-1a injections using data from RebiSmart®.MethodsThis was a single-group, observational, retrospective audit. Adherence data were collected from patients with relapsing multiple sclerosis in the United Kingdom and Ireland who had been prescribed sc IFN β-1a and had been using RebiSmart® for a minimum of 24 months.ResultsIn total, 225 patients were included in the full analysis set; 72% were in the United Kingdom, and 28% were in Ireland. Overall, the mean age was 44.1 years, and 73% were women. Patients received sc IFN β-1a 44 µg (68%) or 22 µg (32%) three times per week. Mean adherence over the course of 24 months was 95.0% (median, 99.4%), and similar values were observed across all periods. The proportion of patients with 80% or higher adherence was 92.0% at 12 months and 91.1% at 24 months.ConclusionHigh adherence to sc IFN β-1a was observed across all patient groups using RebiSmart®, according to 2-year treatment adherence data. This may be partly attributed to the expert support patients received, supplemented by routine and regular contact from the MySupport patient-support program, as well as the self-motivation of patients who persisted with treatment for 2 or more years.

Estimate of fetal weight by ultrasound within two weeks of delivery in the detection of fetal macrosomia.

Delivery of a macrosomic fetus can be linked with significant maternal and perinatal morbidity. Detection of the macrosomic fetus prior to delivery could have a significant impact on reducing that morbidity. The purpose of this study was to determine the likelihood of detection of macrosomia at the time of labour and delivery admission using ultrasound. Retrospective review using the electronic medical record and delivery room logs to identify women admitted to labour and delivery with a birthweight of ≥4000g. There were 272 macrosomic neonates delivered between January 2010 and December 2012, of which, 91 (33.46%) were identified as macrosomic by ultrasound. Using Spearman correlation, the association between the estimated fetal weight by ultrasound and birthweight was r=0.214 (95% CI: 0.098-0.325; P=0.0004). In bivariate analyses, only White race was significant for macrosomia detection with 59 of 149 (39.6%) identified compared with 32 of 123 (26.02%) (P=0.020) non-White people. In the multivariate model, race remained significant. The odds of being labelled macrosomia for White people was 2.051 (95% CI: 1.188-3.542) compared with non-White people (P=0.010). Only 33% of fetuses whose birthweight was ≥4000g were identified by a labour and delivery ultrasound. White race was the only significant factor that increased the odds of having a correct diagnosis of macrosomia by ultrasound.

Structure Analysis of Volcanic Rock Based on the Texture Feature in Imaging Logging

The rock structure information is a very important feature in the complex lithology identification. However, conventional logging response characteristics of the rock structures are very weaker, resulting that the recognition rate of complex lithology is very low in conventional logging. With the help of imaging logging data with accurate, intuitive structural characteristics of the rock, the volcanic structure is analyzed in electronic imaging logging data in this paper. First, several structural characteristics of volcanic rock are introduced. Then, several texture features are extracted based on image processing method. Finally, imaging logging response characteristics of different volcanic structures are analyzed by means of histogram, and some texture features of imaging logging are chosen to identify volcanic structures in the cross-plot method. Real data processing analysis results show that texture features extracted from electrical imaging logging is effective to distinguish the structures of volcanic rocks.

Timing Matters: HIV Testing Rates in the Emergency Department.

Study Objectives. In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED). Methods. We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates. Results. During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly (P < 0.001) more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. (P < 0.01) and followed by patients arriving between 5–5:59 a.m. and 10–10:59 p.m. (P < 0.05) compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September (P < 0.001) were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May (P < 0.001) were less likely to agree to be tested for HIV. Conclusion. Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED.

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Introduction: Over the years, Intensive Care Unit admissions have increased.The management of critically ill patients is multidisciplinary & requires utilization of lots of resources resulting in higher cost of care. Route of admissions to ICU seems to play a pivotal role in the resource utilization and outcome of patients admitted to ICU. Methods: Data extracted from electronic MICU admissions log, covering the period 2011 - 2012. Routes of admission were categorized as patients admitted Emergency Medicine (ER), In-Hospital Transfers (IHT) including patients from in-hospital ICUs, wards, operative room & patients transferred via Rapid Response Team( RRT) and Transfers from Outside (OSH) which included patients from other hospitals, nursing homes, home etc. Acute Physiologic Score (APS) was collected for each patient at the time of ICU admission. Results: Of 5612 admissions to Medical ICU, 2941(52%) were from ER with mean APS of 11.7, 1355 (24%) were from IHT with mean APs of 13.9, and the remaining 25% were from OSH with mean APS of 14.3. Average age at the time of MICU admission was 55 yrs and when compared against each group it was more or less similar. Females comprised of about 48% of overall admissions. Overall mortality was 11.9%, mortality rate among patients admitted from ER was 7.5 % as compared to 16.9% and 16.7% respectively among patients admitted from IHT & OSH. Conclusions: Even though, greater number of patients were admitted from ER to MICU, patients were relatively less sicker at the time of admission and mortality rate was also lower compared to patients admitted from other routes of admission.