Emergency Department Health Care Providers Research Articles

SARS-CoV-2 mRNA vaccine induces robust specific and cross-reactive IgG and unequal neutralizing antibodies in naive and previously infected people

Understanding vaccine-mediated protection against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is critical to overcoming the global coronavirus disease 2019 (COVID-19) pandemic. We investigate mRNA-vaccine-induced antibody responses against the reference strain, seven variants, and seasonal coronaviruses in 168 healthy individuals at three time points: before vaccination, after the first dose, and after the second dose. Following complete vaccination, both naive and previously infected individuals developed comparably robust SARS-CoV-2 spike antibodies and variable levels of cross-reactive antibodies to seasonal coronaviruses. However, the strength and frequency of SARS-CoV-2 neutralizing antibodies in naive individuals were lower than in previously infected individuals. After the first vaccine dose, one-third of previously infected individuals lacked neutralizing antibodies; this was improved to one-fifth after the second dose. In all individuals, neutralizing antibody responses against the Alpha and Delta variants were weaker than against the reference strain. Our findings support future tailored vaccination strategies against emerging SARS-CoV-2 variants as mRNA-vaccine-induced neutralizing antibodies are highly variable among individuals.

Development and Validation of A New Islamic Work Ethics Scale for Healthcare Providers in Emergency Departments (EDIWES)

Purpose: Research on work ethics has acquired considerable scholars’ attention. Research on employees’ religion-oriented ethics, particularly Islamic Work Ethics (IWE), has remained relatively narrow in healthcare settings. This study aims to develop and validate a scale to measure Healthcare Providers (HCPs) IWE in Emergency Departments (EDs). Design/methodology/approach: This study was conducted on HCPs who work at EDs in Jordan. The scale goes through a series of validation processes, including content validity, face validity, and construct validity. This study employed exploratory factor analysis for construct validity and Cronbach’s alpha for reliability analysis. Findings: Exploratory factor analysis yielded 17 strong explanatory items on a three-dimension scale, namely obligation of HCP to their patients, obligation of supervisors to their subordinates and obligation of HCP to their colleagues. Conclusion: The findings of this study provide a valid and reliable scale that had a satisfactory psychometric property for measuring Healthcare Providers’ IWE in EDs.

210 Assessment of Emergency Department Health Care Providers’ Readiness for Intimate Partner Violence Screening and Correlation With Cultural Competence

Intimate partner violence (IPV) is a serious public health issue and emergency departments (ED) are often a victim’s only contact with healthcare providers (HCPs). The ED also increasingly serves as a primary source of care for racial/ethnic minorities and other historically marginalized groups because of rising healthcare costs and declining access to care. The need for culturally competent providers, resources, and messaging when addressing IPV cannot be overstated. To inform more inclusive IPV screening strategies, this study explored the intersectionality of IPV readiness and cultural competence among ED HCPs.

Heat Emergencies: Perceptions and Practices of Community Members and Emergency Department Healthcare Providers in Karachi, Pakistan: A Qualitative Study

Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.

I'm here because I was told to come: a study of cancer patients' reasons for attending the emergency department.

Patients with cancer are seen frequently in emergency departments (EDs). It has been proposed that many of these visits are preventable, but the patient perspective has not been well-studied. We conducted structured interviews with a convenience sample of patients who presented to a single ED with a cancer-related complaint. We asked standardized questions regarding patient predisposing characteristics, enabling factors (e.g., access to support), and perceived need for care. We compared the reported perceived need with the evaluated need by ED healthcare providers. Themes were identified using descriptive content analysis. Forty-five patients completed interviews, of whom 30 (67%) were admitted to hospital. The most frequent reasons for seeking ED care were pain (includes abdominal) (33%), fever (11%), and weakness (11%). The majority (77%) did not make the decision to go to the ED alone: healthcare providers (40%, most commonly oncologists) and caregivers (36%) were the reported decision-makers in these cases. The majority (73%) felt their ED visit was not preventable. Themes of an alternative oncological setting for tests, improved community services, and both earlier medication management and referral to specialist care were identified from patients who reported their visit was avoidable. Congruence between (patient) perceived need and evaluated need was high (96%). The minority of patients made the decision to seek ED care by themselves. While the majority did not believe emergency care was avoidable, those who did had cogent suggestions to that end. Patient's assessments of their own need had high agreement with ED providers' evaluations.

Opiophobia in Emergency Department Healthcare Providers: A Survey in Western Switzerland.

Opiophobia contributes to oligoanalgesia in the emergency department (ED), but its definition varies, and its association to healthcare providers’ personality traits has been scantly explored. Our purpose was to study the different definitions of opiophobia and their association with two personality traits of doctors and nurses working in EDs, namely the stress from uncertainty and risk-taking. We used three online questionnaires: the ‘Attitude Towards Morphine Use’ Score (ATMS), the Stress From Uncertainty Scale (SUS) and the Risk-Taking Scale (RTS). Doctors and nurses from nine hospital EDs in francophone Switzerland were invited to participate. The ATMS score was analyzed according to demographic characteristics, SUS, and RTS. The response rate was 56%, with 57% of respondents being nurses and 63% women. Doctors, less experienced and non-indigenous participants had a significantly higher ATMS (all p ≤ 0.01). The main contributors of the ATMS were the fear of side effects and of addiction. In multivariate analysis, being a doctor, less experience and non-indigenous status were predictive of the ATMS; each point of the SUS increased the ATMS by 0.24 point. The fear of side effects and of addiction were the major contributors of opiophobia among ED healthcare providers; opiophobia was also associated with their personality traits.

Potentially Inappropriate Prescriptions to Older Patients in Emergency Departments in South Korea: A Retrospective Study

PurposeThe purpose of this study was to evaluate the incidence of the administration of potentially inappropriate medications (PIMs) and the potential drug–drug interactions (pDDIs) in older patients in emergency departments (EDs) over a 12-month period and to identify the factors associated with the administration of PIMs.Patients and MethodsThis retrospective study was conducted using the electronic medical records from two university-affiliated teaching hospitals in South Korea. ED visit cases of patients aged 65 and older from January 1, 2013, to December 31, 2013, were included in the analysis. Among the medications administered in ED, PIMs or pDDIs were identified using a drug utilization review program available in Korea.ResultsDuring the study period, a total of 13,002 ED visit cases were reported from 10,686 patients. The proportion of ED visit cases with any PIM was 79.2% and the average number of PIMs was 2.7 (range, 1–17). The most commonly administered PIMs that were contraindicated or should have been used with caution were ketorolac (41.3%) and metoclopramide (10.3%), respectively. Multivariate regression analysis indicated that female patients (p = 0.012), patients with more than six drugs in the ED (p < 0.001), and visits longer than 300 minutes (p = 0.026) were significantly associated with PIM administration in the ED. Potential DDIs between the medications administered in EDs were observed in 20.5% of total visit cases, with ketorolac being the most frequently reported drug in contraindicated drug combinations.ConclusionThis study demonstrated a high incidence of the administration of PIMs and medications with pDDIs in older patients in EDs and revealed the characteristics that are significantly associated with an increased risk of PIM administration. Healthcare providers in EDs should consider the risk of administering PIMs or medications with pDDIs, especially when treating older patients.

The importance of the number of tracheal intubation attempts at the Emergency Department of King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia

Background: Tracheal intubation (TI) is an intervention in the Emergency Department (ED) to stabilise children and to protect the airway. The aim of the study was to investigate the prevalence of TI, the number of attempts to achieve successful intubation, the indications and the adverse outcomes related to TI in the paediatric population. Methods: A quantitative cross-sectional study, using a chart review of the hospital's electronic database, was conducted with paediatric patients who required intubation, from May 2015 to the current date. Results: A total of 159 paediatric patients' records were analysed. The proportion of a successful first intubation attempt was 87.4% (n = 139), two attempts 6.9% (n = 11), and three or more attempts 5.7% (n = 9). The most frequent indication for TI in the sample was trauma (35.3%, n = 55). In terms of TI-related complications, 22% (n = 35) experienced at least one complication. Of the successful first attempt group, cardiac arrest without return of spontaneous circulation (ROCS) was observed in 12.9% (n = 18). Other TI-related adverse events included hypotension requiring treatment (5.8%, n = 8), emesis (1.4%), bleeding through the tube (2.9%) and secretions via the tube (2.9%). For the two attempts group (n = 11), 18.2% (n = 2) had secretions from the tube and 18.2% experienced bleeding through the tube. For the three or more attempts group, cardiac arrest with ROCS (22.2%, n = 2), and secretions from the tube (22.2%, n = 2), were observed. The majority (96.2%) of the patients had a successful extubation, 8.7% (n = 13) experienced postextubation stridor, 2% (n = 3) became agitated, and 5.3% (n = 8) experienced respiratory distress. Conclusion: The TI success rate was 87.4%, and adverse outcomes occurred in 22% of all attempts. There is a higher prevalence of TI-related adverse events with multiple attempts to intubate. It is urgent that ED healthcare providers maximise their efforts to achieve success with the first intubation.

COVID-19 infection among emergency department healthcare providers in a large tertiary academic medical center following the peak of the pandemic.

The COVID-19 pandemic has spread through the US during the last few months exposing healthcare providers to possible infection. Here we report testing of emergency department (ED) healthcare providers (HCP) for exposure to COVID-19 through lateral flow point of care (POC) and lab-based enzyme-linked immunosorbent assay (ELISA), and RTq-PCR for evidence of acute infection.138 ED HCP were tested between May 26th (approximately one month after the peak of COVID-19 first wave of cases) and June 14th. Enrolled ED HCP represented about 70% of the total ED HCP workforce during the study period. Subjects were tested with a POC COVID-19 antibody test, and standard ELISA performed by a university-based research lab. Subjects also provided a mid-turbinate swab and a saliva specimen for RTq-PCR. All subjects provided demographic information, past medical history, information about personal protective equipment (PPE) use, COVID-19 symptoms, as well as potential COVID-19 exposures during the previous 4 weeks, both in the ED, and outside the clinical setting.None of the HCP had positive RT-PCR results; 7 HCP (5%) had positive IgG for COVID-19; there was strong agreement between the lab-based ELISA (reference test) and the POC Ab test (P ≤ 0.0001). For the POC Ab test there were no false negatives and only one false positive among the 138 participants. There was no significant difference in demographic/ethnic variables, past medical history, hours worked in the ED, PPE use, or concerning exposures between seropositive and seronegative individuals. Moreover, there was no significant difference in reported symptoms between the two groups during the previous four weeks.The rate of COVID-19 seroconversion in our ED was 5% during the month following the pandemic's first wave. Based on questionnaire responses, differences in demographics/ethnicity, medical history, COVID-19 exposures, and PPE use were not associated with ED HCP having been infected with SARS-CoV-2. In the setting of our limited cohort of subjects the COVID-19 POC Ab test performed comparably to the ELISA lab-based standard.

Use of In Situ Simulation to Improve Emergency Department Readiness for the COVID-19 Pandemic.

During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety. One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques. This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members' perceived knowledge of ED procedures related to COVID-19 and their airway management skills. A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%). Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

Healthcare providers\u2019 perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain

BackgroundWorldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom.MethodsA self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs’ perceptions of FPDR were generated using the 5-point Likert scale.ResultsSurveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses.ConclusionThe study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.

48 Paediatric intubation in an adult-based community hospital emergency department (ED)

Abstract Background Airway intubation is a high-risk procedure, especially in the paediatric population. Training ED healthcare providers is challenging because it is rare. Success and adverse events (AEs) could be due to patients’ illness, the health professional intubating, and hospital factors. Objectives Describe paediatric intubations in an adult community-based hospital, with primary outcomes being first-pass success and AEs. The secondary objective is to determine what factors are association with intubation success and related AEs. Design/Methods Retrospective chart review of patients &amp;lt; 18 years intubated in the ED between Jan 1, 2006 and Mar 31, 2017 (demographics, intubation details, physiologic outcomes). Analysis: descriptive and comparative statistics (intubations with vs. without AEs), p&amp;lt;0.05 significant. Results n=121 intubations occurred in the ED over the 10-year period. Mean (standard deviation) age 6.9 (6.8) years. First pass success occurred in n=76 (62.8%), and 33 (27.3%) second pass success. There was n=22 (18.2) minor AEs, n=3 (2.5) major AEs. There were no significant differences between profession intubating and first pass success (p=0.384), or AEs (p=0.472), Table 1. Indications for intubation included respiratory and/or oxygenation failure n=54 (44.6%), airway protection n=51 (42.2%), airway obstruction n=4 (3.3%), cardiopulmonary arrest n=2 (1.7%) [n=9 missing]. Use of specialized equipment was used in n=19 of the intubations, n=12 on first attempt, 8 second attempt, 4 third attempt. No accidental extubations occurred, but the ETT was repositioned in n=33 (27%) after first intubation. Conclusion Pediatric intubation in an adult community-based hospital is rare. Success rate of intubation on first attempt is low with minor AEs. There was no significant difference between the type of health professional intubating. These results will inform the development of tools and education for paediatric advanced airway management in adult community-based hospitals, and enhance patient outcomes in the ED.

A qualitative study of workplace violence among healthcare providers in emergency departments in India

BackgroundEmergency department (ED) workplace violence is increasingly recognized as an important issue for ED providers. Most studies have occurred in developed countries with established laws and repercussions for violence against healthcare providers. There is a paucity of data on workplace violence against ED providers in less developed countries. The aim of this study was to learn more about workplace violence among healthcare providers in EDs in India.ResultsSemi-structured interviews were conducted in-person with physicians, nurses, and paramedics in Indian EDs. Interviews were coded independently using the NVivo qualitative research software. A hybrid thematic analysis approach was used to determine dominant themes. Sixty-three interviews were conducted at 7 sites across India. Interview participants include attending physicians (11), resident physicians (36), nurses (10), and paramedics (5). Events were most often described as involving accompanying persons to the patient, not the patient themselves. Most events involved verbal abuse, although a significant percentage of responses described some kind of physical violence. ED factors such as busy times with high patient volumes or periods of waiting are associated with increased violence, as well as incidents with unanticipated outcomes such as patients with severe illness or death. Decreased levels of health literacy among patients often contribute as the financial stressors of paying for medical care. Providers reported negative consequences of workplace violence on quality of care for patients and their own motivation to work in the ED. Communication strategies were frequently proposed as interventions to mitigate violence in the future including both provider communication as well as public awareness campaigns.ConclusionWorkplace violence is a frequent reality for this sample of Indian ED healthcare providers. Alarming levels of verbal and physical abuse and their impact on patient care are described. This qualitative study identified unique challenges to Indian ED providers that differ from those in more developed settings, including financial stressors, inadequate enforcement of rules governing behavior in the hospital, and an overwhelming frequency of violence emanating from patient family members and attendants rather than the patients themselves. Further investigation into preventive strategies is needed.

LO53: Emergency department visits for hyperglycemia: through the eyes of the patient

Introduction: Patients with poorly-controlled diabetes often visit the emergency department (ED) for treatment of hyperglycemia. While previous qualitative studies have examined the patient experience of diabetes as a chronic illness, there are no studies describing patients’ perceptions of ED care for hyperglycemia. The objective of this study was to explore the patient experience regarding ED hyperglycemia visits, and to characterize perceived barriers to adequate glycemic control post-discharge. Methods: This study was conducted at a tertiary care academic centre in London, Ontario. A qualitative constructivist grounded theory methodology was used to understand the experience of adult patient partners who have had an ED hyperglycemia visit. Patient partners, purposively sampled to capture a breadth of age, sex, disease and presentation frequency were invited to participate in a semi-structured individual interview to probe their experiences. Sampling continued until a theoretical framework representing key experiences and expectations reached sufficiency. Data were collected and analyzed iteratively using a constant comparative approach. Results: 22 patients with type 1 or 2 diabetes were interviewed. Participants sought care in the ED over other options because of their concern of having a potentially life-threatening condition, advice from a healthcare provider or family member, or a perceived lack of convenient alternatives to the ED based on time and location. Participants’ care expectations centred around symptom relief, glycemic control, reassurance and education, and seeking referral to specialist diabetes care post-discharge. Finally, perceived system barriers that challenged participants’ glycemic control included affordability of medical supplies and medications, access to follow-up and, in some cases, the transition from pediatric to adult diabetes care. Conclusion: Patients with diabetes utilize the ED for a variety of urgent and emergent hyperglycemic concerns. In addition to providing excellent medical treatment, ED healthcare providers should consider patients’ expectations when caring for those presenting with hyperglycemia. Future studies will focus on developing strategies to help patients navigate some of the barriers that exist within our current limited healthcare system, enhance follow-up care, and improve short- and long-term health outcomes.

Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol

IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the...

Children as a vulnerable group in mass gathering

Background: A mass gathering (MG) is defined as a collection of at least 1000 people at a single location over one to several days or weeks. Potential sites for a disaster include festivals, sporting events, conventions, refugee camps, globalization by travel, and might involve a wide range of age groups. The potential number of patients and illnesses or injuries is affected by environmental, biochemical, and psychological factors. Identified issues: Children are vulnerable to higher rates of illnesses or injuries due to multiple factors such as their anatomical and physiological differences in comparison to adults, lower motor and cognitive skills, and inability to know how and when to escape from danger. Children emergency cases are challenging and difficult to handle for healthcare providers in MG incidents due to some factors such as lack of pediatric cases, lack of training and experience in dealing with children, unfamiliarity with using the special equipment for treating children, communication barriers, the absence of a caregiver or personal identification card, inability to provide medical and allergic histories. The use of personal protective equipment can also complicate the assessment and treatment process as it may frighten children. In preparation for the FIFA World Cup 2022 in Qatar the figures to take into consideration are presented in . We aim to propose strategies to enhance the safety and care of children involved in MGs. Results: Although they represent a very small proportion of the population in Qatar, children need special strategies from an emergency management viewpoint which we are proposing in . Adequate preparation is the responsibility of pre-hospital and emergency department healthcare providers, children healthcare agencies, and emergency managers. Conclusion: Several factors make children more vulnerable in mass gatherings incidents and this needs to be considered in emergency preparedness. A multi-disciplinary management team approach should be emphasized, developed, and disseminated through continuing professional development courses.

Home Accidents among Children: A Retrospective Study at a Tertiary Care Center in Oman.

ObjectivesWe sought to identify the prevalence, commonest causes, and severity of home accident injuries and their effects on children who present to the emergency department (ED) of a university-tertiary hospital in Oman.MethodsWe conducted a retrospective study among children aged ≤ 18 years old who presented with home accidents to the ED between January and June 2017. A checklist for data collection was designed to include demographic data, causes and effects of home accidents, and treatment outcomes. The data was retrieved from the hospital electronic patient records.ResultsA total of 1333 children presented to the ED over six months as a result of unintentional home accidents, giving a prevalence of 7.7% from all children who visited the ED. There was a significant male to female ratio of 1.7:1. The most prevalent causes for home accidents were ‘falls’ in 716 (53.7%) children, followed by ‘struck by/against-animate/inanimate mechanical force’ in 201 (15.1%) children. ‘Poisoning’ was the third major cause in 117 (8.8%) children. Severity scale showed that around 36.0% of children suffered from severe injuries and 5.4% were admitted to the hospital.ConclusionsDespite this study being a single-center study in Oman, it indicates a high prevalence and severity of unintentional home accidents among children. The study findings suggest the need for implementing strategies to raise public awareness of child safety at home and to improve the preparedness of healthcare providers in ED to deal with such accidents.

Workplace violence against healthcare providers in emergency departments in Saudi Arabia

Introduction: Emergency departments (EDs) have been identified as the highest risk area within a hospital to be exposed to workplace violence (WPV). This study aimed to estimate the prevalence of WPV against healthcare providers in EDs in Saudi Arabia, to explore the experiences and attitudes of ED staff toward WPV, and to identify the possible risk factors for WPV. Methods: A cross-sectional survey study was conducted with physicians and nurses working in 37 EDs in three provinces in Saudi Arabia, using a convenient sampling method. Over a 1-year period, 787 ED staff members were contacted and a 60% response rate was achieved. Results: The 1-year prevalence of at least one violent act against ED staff was 45%. Verbal threats were the most common type of WPV (42%). The study found that the prevalence of WPV against physicians (47%) was higher than against nurses (41%). However, when comparing the physician and nurse groups, none of the types of WPV was statistically significant. More female participants were exposed to stalking compared to male participants (OR 0.38; 95% CI 0.15–0.92). Non Arabic speakers experienced more WPV in the form of verbal threats and physical assault than the Arabic speaking group (OR 0.14; 95% CI 0.03–0.75). Participants working at the Ministry of Health hospitals were more likely to be exposed to a confrontation when off-duty and to stalking. Conclusion: Almost half of the ED physicians and nurses experienced one or more WPV incident during a 12-month period.

Implementation of Chest Compression Feedback Technology to Improve the Quality of Cardiopulmonary Resuscitation in the Emergency Department: A Quality Initiative Test-of-change Study.

BackgroundCardiopulmonary resuscitation (CPR) metrics including compression rate and depth are associated with improved outcomes and the need for high-quality CPR is emphasized in both the American Heart Association (AHA) and Heart and Stroke Foundation of Canada (HSFC) guidelines. While these metrics can be utilized to assess the quality of CPR, they are infrequently measured in an objective fashion in the emergency department.ObjectivesAs part of an Emergency Department (ED) Quality Improvement (QI) project, we sought to determine the impact of real-time audio-visual (AV) feedback during CPR amongst ED healthcare providers.MethodsParticipants performed two minutes of uninterrupted CPR without AV feedback, followed by two minutes of CPR with AV feedback after a two-minute rest period in a simulated CPR setting. CPR metrics were captured by the defibrillator and uploaded to review software for analysis of each event.ResultsThe use of real-time AV feedback resulted in a significant improvement in the number of participants meeting AHA/HSFC recommended depth (38%, p = 0.0003) and rate (35%, p = 0.0002). Importantly, ‘compressions in target’, where participants met both rate and depth simultaneously, improved with AV feedback (19 vs 61%, p < 0.0001).ConclusionsWe found a significant improvement in compliance with CPR depth and rate targets as well as ‘compressions in target’ with the use of real-time AV feedback during simulation training. Future research is needed to ascertain whether these results would be replicated in other settings. Our findings do provide a robust argument for the implementation of real-time AV CPR feedback in Hamilton Emergency Departments.

Complications of subcutaneous penile modifications: a discussion of emergency department presentations and management

BackgroundSubcutaneous penile modifications (SPMs) are more prevalent in Southeast Asian culture and have been growing in popularity in Western culture. SPMs are often made of domino tiles, or other available pieces of plastic, shaved into a desired shape and placed in unsterile conditions. Previous literature indicates a high risk of infection and the need for surgical removal.Case presentationsSeven patients presented to the emergency department in the Southwest border region with complications from SPMs. All the patients complained of pain, four presented with signs of infection, and four SPMs required removal in the emergency department. Removal consisted of a dorsal penile nerve block and making an incision over the SPM to remove the foreign body. Three of the patients had their SPMs done during a previous incarceration under unsterile conditions.ConclusionsSPMs appear to be growing in popularity among Western culture, and emergency department health care providers should be aware of trends in body modifications as well as potential complications. The conditions in which SPMs are often placed pose a high risk for infection. In some cases, placement and/or removal of SPMs pose a risk of damage to the corpora, arteries, and nerves of the penis. In the absence of overt bleeding, or suggestion of neurologic injury, dorsally placed superficial foreign bodies of the penis may be amenable to emergency department removal.