Emergency Departments In Denmark Research Articles

Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study

ObjectiveTo estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure...

Readmission trends before and after a national reconfiguration of emergency departments in Denmark.

In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates. We included all unplanned hospital admissions (aged ≥18years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes. The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]). Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.

Oilcloth sessions as an implementation strategy: a qualitative study in Denmark

BackgroundThe aim of this study was to explore healthcare professionals, managers, and other key employees’ experiences of oilcloth sessions as a strategy when implementing new emergency departments in Denmark, based on their participations in these sessions. The study addresses the importance of securing alignment in implementation strategies. Too often, this does not get enough attention in the literature and in practice. In this study, alignment among components was achieved in an educational implementation strategy called oilcloth sessions.MethodsThe study is based on participants’ observations of 13 oilcloth sessions and follow-up via 53 semi-structured interviews with the board of directors, managers, and key employees from the present emergency department and different specialty departments. Data were analysed deductively using Biggs and Tang’s model of didactic alignment.ResultsThe analysis showed the complexity of challenges when using oilcloth sessions as a strategy when implementing a new emergency department described in terms of three phases and nine main themes (a–i): the preparation phase: (a) preparing individually and collectively, (b) objectives, (c) involving participants, (d) selecting cases; the execution phase: (e) using materials, (f) facilitating the sessions, (g) temporal structures; evaluation: (h) following up on the sessions, (i) adapting to the context.ConclusionsThis study shows that it is important to ensure alignment among elements in implementation strategies. Thus, oilcloth sessions with high alignment are useful if the challenges experienced are to be overcome and the strategy will be experienced as a useful way to support the implementation of a new emergency department from the participants’ point of view. Bigg and Tang's didactic model is useful as an analytical framework to ensure alignment in implementation strategies in general.

Do we know the mind of others? Suspicion of malingering in emergency psychiatry

Introduction Malingering can be divided into simulation and exaggeration of symptoms. Malingering has traditionally been considered rare in general psychiatry. In contrast to earlier estimates, more recent studies report that doctors suspect malingering frequently in psychiatric emergency departments. The aim of this study is to survey how often doctors in psychiatric emergency units in a public, free-of-charge, mental health service suspect that patients are malingering, and which diagnoses, symptom complaints and suspected reasons for malingering doctors ascribe to their patients. Methods Questionnaires were distributed in three psychiatric emergency departments in Denmark. Suspected simulation and exaggeration were rated with a 5-point scale. Doctors were encouraged to write down the symptoms and perceived causes for suspected malingering. Results 362 questionnaires were filled in. 25% of all patients were suspected of simulating to some degree. 8% of patients were highly suspected or definitely believed to be simulating. Patients complaining of suicidal ideation were most frequently suspected of malingering. ‘Attention seeking’ was the most common suspected reason for malingering. Patients with diagnoses of substance use and personality disorder were the most suspected of malingering. Conclusion This is the first study to investigate doctors’ suspicions of psychiatric malingering in a European setting. Patients with established personality and substance use disorder are at higher risk of being suspected of malingering, which potentially affects the course of treatment significantly. The rise in suspected malingering is conspicuous and requires further investigation. Doctors are encouraged to act conservatively upon suspicion of malingering in emergency psychiatry.

First year residency in Emergency Medicine in Denmark

Background:  Emergency Medicine is the youngest Danish medical specialty, finally adopted in 2017 with the first residents enrolled in 2018. The residency consists of 1 year introduction employment with a primary residency spanning 5 years after the introduction year. The 1-year program consists of different setups of time in certain specialty areas, encompassing the primary specialties internal medicine, abdominal surgery and orthopedic surgery. The education programs can be differently structured, but with the same end qualifications for the resident. We aimed to investigate the different structures of the education programs for the 1st year residency in Emergency Medicine in Denmark. Methods: All education programs were extracted from the three different medical educational regions in Denmark in March 2020. We reviewed all programs and the following data was extracted: Time in each primary specialty, medical courses, possibility to practice the role of team leader in critical ill patients and education in point-of-care ultrasound.Results: 20 of 21 emergency departments in Denmark employs residents in Emergency Medicine for their 1-year introductory residency. 13 of 20 programs assess patients in internal medicine and abdominal surgery in the same time period. 7 out of 20 has pre-specified time for patients in abdominal surgery. 10 of 20 programs does not have specified time in orthopedic surgery. This is part of the internal medicine period or not specified further. Only programs in The Region of Southern Denmark have pre-specified periods for all three main specialties. 14 of 20 programs present opportunity to participate in medical courses such as Advanced Life Support. Only 3 of 20 programs present opportunity for further education in point of care ultrasound, other than the obligatory focused lung ultrasound and ultrasound guided peripheral access. 7 of 20 programs present opportunity to participate in primary assessment of critical ill patients as team leader or observer, for critical care calls. Conclusion: The education programs in Denmark for Emergency Medicines 1st year residency varies greatly in both time in major specialties, medical courses, point-of-care ultrasound and training in the role as team leader.

Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study.

Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf. This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals. A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n=17). The qualitative content analysis was guided by Graneheim and Lundman's concepts. The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model. Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.

A cross-sectional survey of knowledge pertaining to IV fluid therapy and hyponatraemia among nurses working at emergency departments in Denmark

IntroductionInappropriate fluid therapy may induce or worsen existing hyponatraemia with potentially life-threatening consequences. Nurses have an important role in assisting physicians in IV fluid prescribing. However, research is lacking in Denmark about nurses’ knowledge pertaining to IV fluid therapy and hyponatraemia. MethodsAn explorative cross-sectional survey was performed among Danish emergency department nurses in Spring 2019. Knowledge about IV fluid therapy was assessed for three common clinical scenarios, and multiple-choice questions were used to measure knowledge about hyponatraemia. Results112 nurses responded to all scenario questions corresponding to 6.2% (112/1815) of the total population of nurses working at emergency departments in Denmark. In two of the three scenarios, a minority of nurses (8–10%) inappropriately selected hypotonic fluids. Nearly one third (31%) selected a hypotonic fluid for a patient with meningitis, which is against guideline recommendations. The study revealed limited knowledge about severe symptoms of hyponatraemia, patients at high risk, and hyperglycaemia-induced hyponatraemia. ConclusionIn accordance with guideline recommendation, the majority of nurses did not select hypotonic fluids in three clinical scenarios commonly encountered in the emergency department. However, when setting up an educational program, further awareness is needed regarding symptoms of hyponatraemia, high-risk patients, and hyperglycaemia-induced hyponatraemia.

Investigating the use of physical restraint of children in emergency departments: AScandinavian survey.

The aim of the study is to describe the current frequency of physical restraint and the use of analgesics and sedatives for treating pediatric pain in emergency departments (EDs) in Scandinavia. We performed a nation-wide electronic survey asking nurses in the emergency departments in Denmark, Norway, and Sweden about their experience treating children in pain. Responses from 103 Danish, Norwegian and Swedish nurses were included (79% response rate). Physical restraint was reported used at 79% [70.0-85.9] (N=78) of the surveyed departments (DK: 96%, NO: 67%, SE: 77%) with two participants reporting daily use of physical restraint. Paracetamol was available at all departments and used most frequently. Sedation was available at 88% [78.8-92.0] of the departments with midazolam as the most recurrent sedative (83%, [74.8-89.4]). Seventy-three percent of respondents reported a need for better treatments. Lack of education was the most frequently reported obstacle for providing both pain treatment (29%) and sedation (43%) followed by lack of guidelines. Physical restraint of children during painful procedures is used in the majority of Scandinavian emergency departments (79%). There appears to be a lack of local guidelines for both pain treatment and sedation.

Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices.

Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

New-Onset Atrial Fibrillation Among Patients With Infection in the Emergency Department: A Multicenter Cohort Study of 1-Year Stroke Risk

BackgroundPatients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (EDs) and may require antithrombotic therapy because of the increased risk of stroke. Our objective was to describe the 1-year risk of stroke in patients in the ED with infection, new-onset atrial fibrillation, and no antithrombotic therapy. MethodsThis was a population-based cohort study at 4 EDs in Denmark and Sweden. Atrial fibrillation was identified by electrocardiogram (ECG) upon arrival at the ED, and infection was identified by discharge diagnosis. Patient history was followed for 12 months or until initiation of oral anticoagulant therapy, ischemic stroke, or death. Primary outcome was stroke within 12 months compared to patients with infection and no atrial fibrillation. ResultsIn the analysis, 15,505 patients were included; 48.7% were male and the median age was 71 (IQR, 56-83). Among the included patients, 2107 (13.6%) had atrial fibrillation of any kind and 822 (39.0%) of these had new-onset atrial fibrillation with a median CHA2DS2-VASc score of 3 (IQR 2-4).New-onset atrial fibrillation during infection showed an absolute postdischarge 1-year risk of stroke of 2.7% (95% CI 1.6-4.2), corresponding to a crude hazard ratio (HR) of 1.4 (95% CI 0.9-2.3), a sex and age adjusted HR of 1.0 (95% CI 0.6-1.6), and a CHA2DS2-VASc adjusted HR of 1.1 (95% CI, 0.7-1.8) compared to patients with infection but no atrial fibrillation. ConclusionsPatients in the ED with infection and new-onset atrial fibrillation without current oral anticoagulant therapy had a 2.7% absolute 1-year risk of stroke. Stroke events were mainly related to sex and age and risk factors identified by the CHA2DS2-VASc score.

Utilization of a Novel Patient Monitoring Dashboard in Emergency Departments.

To study the clinical use of a novel patient monitoring dashboard at two Emergency Departments in Denmark in order to evaluate the clinician's perspective and their use of the dashboard. Data was gathered by participatory observations of the clinicians' workflow and dashboard interaction, as well as interviews about the clinicians' attitudes towards the system. The data collection process took place during the system's intervention process from September to December 2018. 65 nurses, 28 physicians and two assistants were observed in total for 62 hours. The 59 hours of the observation was focused on the interaction with the systems. Additionally, 10 nurses and two project nurses were interviewed, giving their statements about the use of the dashboard. Based on observation, it is concluded that the temporal use of the dashboard is 3 minutes and 10 seconds, out of the 59 hours system interaction. Furthermore, the nurses claimed that they needed further training, as an explanation of the minimal interaction with the system.

Occupational safety across jobs and shifts in emergency departments in Denmark

This paper explores whether occupational safety and health (OSH) risk perceptions, behaviour and exposure differ among Emergency Department (ED) doctors, nurses and medical secretaries, and whether observed safe working conditions and behaviour in EDs vary across work shifts. Staff from four public hospital-based EDs completed a survey regarding safety climate, risk behavior, work pressure, exposure to and reporting of injuries, violence and threats. Furthermore, safety observations of working conditions (e.g. order and tidiness) and behavior (e.g. discarding hypodermic needles) were carried out during day, evening and night shifts. Rates of self-reported violence and threats in ED doctors and nurses were two to three times greater than rates seen for doctors and nurses at hospitals in general. However, ED respondents perceived a greater managerial focus on certain aspects of the safety climate. Work pressure and lack of time (among doctors and nurses) and social pressure (among medical secretaries) were the primary reasons given for taking OSH risks. If OSH incidents (e.g. injuries or violence) were not reported, it was often because the process was perceived as too laborious, and some incidents were considered ‘part of the job’. Observations of order and tidiness in the EDs showed a gradual lower score in safety conditions from the day to the evening and night shift. Multifaceted and integrated interventions for educating and training ED personnel need to take into account their varying risk exposures, perceptions and behaviors in creating and sustaining an efficient, safe and healthy working environment.

Transient risk factors of acute occupational injuries: a case-crossover study in two Danish emergency departments.

Objectives The objectives of this study were to (i) identify transient risk factors of occupational injuries and (ii) determine if the risk varies with age, injury severity, job task, and industry risk level. Method A case-crossover design was used to examine the effect of seven specific transient risk factors (time pressure, disagreement with someone, feeling sick, being distracted by someone, non-routine task, altered surroundings, and broken machinery and materials) for occupational injuries. In the study, 1693 patients with occupational injuries were recruited from a total of 4002 occupational injuries seen in 2013 at two emergency departments in Denmark. Effect estimates were calculated using the matched-pair interval approach. Results Increased risk for an occupational injury was found for time pressure [odds ratio (OR) 1.6, 95% confidence interval (95% CI) 1.3-2.0], feeling sick (OR 2.7, 95% CI 1.9-3.9), being distracted by someone (OR 3.1, 95% CI 2.3-4.1), non-routine task (OR 8.2, 95% CI 5.3-12.5), altered surroundings (OR 20.9, 95% CI 12.2-35.8), and broken machinery or materials (OR 20.6, 95% CI 13.5-31.7). The risk of occupational injury did not vary substantially in relation to sex, age, job task, industry risk level, or injury severity. Conclusion Use of a case-crossover design identified several worker-related transient risk factors (time pressure, feeling sick, being distracted by someone) that led to significantly increased risks for occupational injuries. In particular, equipment (broken machinery or materials) and work-practice-related factors (non-routine task and altered surroundings) increased the risk of an occupational injury. Elaboration of results in relation to hazard period and information bias is warranted.

Prescription of medication before and after acute admission with nonspecific abdominal pain

Background Abdominal pain is among the most common symptoms leading to referral to emergency departments in Denmark. Many of these patients are discharged without a specific diagnosis despite thorough work-up. We set out to assess the drugs prescribed to these patients in order to identify preconditions prior to admission based on their pharmaceutical treatment. This aims to generate hypotheses of admission causes derived from the drugs the patients have been prescribed since knowledge of drugs consumption patterns can improve treatment regimes.

Physicians using ultrasound in Danish emergency departments are mostly summoned specialists.

BackgroundEmergency ultrasound is a relatively new diagnostic discipline. It is used as an extension of the clinical examination and is ideal in the setting of acute illness. The objective of this study was to investigate how many Emergency Departments (EDs) in Denmark have implemented emergency ultrasound. We also wanted to give an idea of how many and which physicians have adopted ultrasound as a diagnostic tool so far.MethodsThe study was a cross-sectional, descriptive, multicenter survey that included all physician staffed EDs in Denmark. An Internet based questionnaire was distributed by e-mail to all heads of department. Those departments who responded that ultrasound was available in their department were included in the second part of the study where all physicians working in the ED were contacted and asked to complete a second questionnaire.ResultsAll 28 eligible EDs participated in the first part of the study (Response rate: 100 %). 25 EDs (89 %, 95 % CI: 85-93) had ultrasound equipment available. Questionnaires were distributed to 1,872 physicians in these departments and 561 responded (Response rate: 30 %, 95 % CI: 28-32). Overall 257 (46 %, 95 % CI: 42-50) were users of emergency ultrasound and 304 were non-users (54 %, 95 % CI: 50-58). The largest group with 146 respondents (25 %, 95 % CI: 21-29) were anaesthetists with merely consult duty in the ED. When looking exclusively on physicians with on-call duty in the ED, thus excluding anaesthetists, only 146 (35 %, 95 % CI: 30-40) were users of ultrasound while 269 (65 %, 95 % CI: 60-70) were non-users. There was a considerable difference regarding age, level of training, and medical specialty between users and non-users. Users were mainly anaesthetists and attending physicians from other departments. The majority of non-users were young physicians with on call duty in the ED.ConclusionsWe have found that although almost all Danish EDs have ultrasound equipment available, few physicians working in the ED seem to have adopted the tool. Emergency Ultrasound is mainly performed by specialists who are summoned to the ED in case of severe acute illness and not by those physicians who comprise the backbone of the ED around the clock.

Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators.

BackgroundThe Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting.MethodsQuasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of an ED. Patients admitted at Nykøbing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbæk Hospital works as a control hospital.Chi-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P < 0.05 was considered statistically significant.ResultsWe assessed 4584 patient cases from RKKP. A significant positive change was seen in all of the additional eight indicators related to stroke at NFS (P < 0.001); however, COPD indicators were unchanged in both hospitals. In NFS two of eight heart failure indicators were significantly improved after the reorganization (p < 0.01). In patients admitted with a bleeding ulcer 2 of 5 indicators were significantly improved after the reorganization in NFS and HOL (p < 0.01). Both compared hospitals showed significant improvements in the two indicators concerning hip fracture (p < 0.001). Significant reductions in the 30 day-mortality in patients admitted with stroke were seen when the pre- and the post-intervention data were compared for both NFS and HOL (p = 0.024).ConclusionsDuring the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark is recommended.

Emergency departments in Denmark with a research responsible consultant expect increased research production

Background Emergency medicine (EM) is not a recognized specialty in Denmark, but an area of competence. In Denmark this is new, and current research production in the Emergency departments (EDs) is limited. As in other areas of clinical medicine, there is a need for research to ensure high quality evidence-based patient care. The aim of our study was to examine 1) the current research activity in the Danish EDs, 2) the impact of having a research responsible consultant on scientific production, 3) the relationship between production and opinion of the head of department with regards to EM as an area of competence respectively a specialty.

National survey of emergency departments in Denmark

Emergency departments (EDs) are the basic unit of emergency medicine, but often differ in fundamental features. We sought to describe and characterize EDs in Denmark. All EDs open 24/7 to the general public were surveyed using the National ED Inventories survey instrument (http://www.emnet-nedi.org). ED staff were asked about ED characteristics with reference to the calendar year 2008. Twenty-eight EDs participated (82% response). All were located in hospitals. Less than half [43%, 95% confidence interval (CI) 24-63%] were independent departments. Thirty-nine percent (95% CI 22-59%) had a contiguous layout, with medical and surgical care provided in one area. The vast majority of EDs saw both adults and children; only 10% saw adults only and none saw children only. The median number of annual visits was 32 000 (interquartile range, 14 700-47 000). The majority (68%, 95% CI 47-89%) believed that their ED was at good balance or capacity, with 22% responding that they were under capacity and 9% reporting overcapacity. Technological resources were generally available, with the exception of dedicated computed tomography scanners and negative-pressure rooms. Almost all common emergencies were identified as being treatable 24/7 in the EDs. Although there is some variation in their layout and characteristics, most Danish EDs have a high degree of resource availability and are able to treat common emergencies. As Denmark seeks to reform emergency care through ED consolidation, this national survey helps to establish a benchmark for future comparisons.

Patient-Experienced Quality in Five Emergency Departments in Denmark: A Multi-Centre Cross-Sectional Questionnaire Survey

Background: Although the implementation of fast tracks for acute patients aims at improving quality and satisfaction in Emergency Departments (EDs), it is unknown whether patients' expectations are being met. Using an interview concept suitable for assessing acute fast-track patients' satisfaction, the study aimed to assess patient-experienced quality in EDs. Method: A multicentre cross-sectional questionnaire survey including 750 patients from five emergency departments in a region in Denmark. The 18 content items and 18 priority items concerned reception, treatment and involvement, information, and time after discharge. Data were collected in telephone interviews. Results: The response rate for the 750 interviews was 65.4%. Responders' mean age was 57.2 years; 42.7% were men. With more than 90% top ratings, patient satisfaction was highest for feeling welcome, comprehensibility of information, and staff courtesy and respect. Confidence in discharge decision increased with admission length (p=0.02), with women expressing significantly better confidence than men (p<0.0001). Conclusion: Staff conduct and information are key issues in the acute patient pathway. Best evaluations and highest priority are given to feeling welcome, comprehensible information, and courtesy and respect. Confidence at discharge increases with hospitalization length. Telephone interviewing is a reliable and valid method.

The use of “brutacaine” in children in emergency departments in Denmark

The use of “brutacaine” in children in emergency departments in Denmark