Emergency Department In Taiwan Research Articles

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

ObjectivesTo investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition.SettingA hospital-based retrospective observational study of a...

The emergency patient's participation in medical decision-making.

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

The Academic Contribution of Emergency Departments in Taiwan: Data on Scientific Publications, 1992-2011

Introduction This study aimed to evaluate the academic contribution of emergency departments (EDs) in Taiwan by analysing scientific publications during the past 20 years. Methods This was an observational study. All data were collected from the 2010 Journal Citation Reports (JCR) and the SciVerse Scopus database. Three groups of publications were enrolled: (1) publications from Taiwan EDs in emergency medicine (EM) journals; (2) publications from Taiwan EDs in non-EM journals; (3) publications from Taiwan who were not affiliated with EDs in EM journals. We collected data regarding the name and category of the journal, the publication year, the publication type, and the number of citations for further analysis. Results A total of 475 publications affiliated with Taiwan EDs appeared in EM journals and 735 appeared in non-EM journals. A total of 389 publications in EM journals affiliated with departments other than EM. The number of publications showed an increasing trend (all p-value <0.001). The number of publications from Taiwan EDs in EM and non-EM journals changed in opposite directions since 2008. Researches from Taiwan EDs were published in 68 categories of journals in addition to EM. Publications in non-EM journals were more frequently cited than were the publications in EM journals. conclusions During the past 20 years, the academic contribution of EDs in Taiwan has increased substantially. The bidirectional change in publication numbers since 2008 constitutes a milestone in the development of EM in Taiwan, and improvements are evident in the quality, quantity, and breadth of research. (Hong Kong j.emerg.med. 2016;23:28-34)

Multi-objective simulation optimization for medical capacity allocation in emergency department

This study aims to investigate medical resource allocation problems by multi-objective simulation optimization to address the long-term overcrowding situations experienced in hospital emergency departments (EDs). With resource constraints considered, decision makers at EDs must determine the number of doctors, nurses, lab technicians, and other medical equipment to allocate efficiently these medical resources and simultaneously minimize the average patient length of stay in the system and the medical resource wasted cost. Therefore, this study first proposes a multi-objective stochastic optimization model to identify the optimal number of all medical resources at the EDs. In addition, a multi-objective simulation optimization algorithm by integrating non-dominated sorting particle swarm optimization (NSPSO) with multi-objective computing budget allocation (MOCBA) and an ED simulation model is developed and constructed to address this problem, respectively. Specifically, NSPSO searches for potential solutions to medical resource allocation problems. MOCBA identifies effective sets of feasible Pareto medical resource allocation solutions and effective allocation of simulation replications. An ED simulation model based on the operation flows of EDs in Taiwan was constructed to estimate the expected performance value of each resource allocation solution generated by NSPSO. The effectiveness and performance of integrated NSPSO and MOCBA was verified by computational experiments.

Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

ObjectiveTo identify and evaluate factors associated with delayed recognition of pulmonary tuberculosis (TB) in the emergency department (ED). BackgroundDelayed recognition of pulmonary TB in ED may precipitate mortality and morbidity. MethodsMedical records of newly diagnosed TB patients admitted to four hospitals in Taiwan were retrospectively reviewed. Patients were divided into two groups based on ED physicians' recognition or not of TB and statistically compared to identify differences in their characteristics. Results310 newly diagnosed TB patients were identified; 150 were unrecognized in the ED. Cough, chest tightness, general malaise, and body weight loss were more common for those with recognized TB. Older age (≥65 yrs, P = 0.035) and chronic renal insufficiency (P = 0.005) were associated with delayed TB recognition. ConclusionOlder age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.

Risk factors for development of chronic kidney disease following renal infarction: retrospective evaluation of emergency room patients from a single center.

BackgroundPrevious studies have analyzed factors associated with renal infarction so that patients can be provided with earlier diagnosis and treatment. However, the factors associated with development of chronic kidney disease (CKD) following renal infarction are unknown.MethodsWe retrospectively reviewed the records of patients with a diagnosis of renal infarction based on enhanced computed tomography. All patients were admitted to a single emergency department in Taiwan from 1999 to 2008. Univariate and multivariate analysis were used to assess the effect of different factors on development of CKD based on estimates of the glomerular filtration rate (eGFR) at admission and at 3–12 months after discharge.ResultsUnivariate analysis indicated significantly increased risk of CKD in patients older than 50 years, with symptoms for 24 h or less before admission, lower eGFR at admission, APACHE II score greater than 7, SOFA score greater than 1, ASA score greater than 2, and SAPS II score greater than 15. Multivariate analysis indicated that only SOFA score greater than 1 was significantly and independently associated with CKD at follow-up (p<0.001).ConclusionsA total of 32.5% of patients admitted for renal infarction over a ten-year period developed CKD at 3–12 months after discharge. A SOFA score greater than 1 was significantly and independently associated with development of CKD in these patients.

Perception of Medical Care Systems and Stress Responses in Preschoolers’ Caregivers at a Pediatric Emergency Department in Taiwan

This study was undertaken to understand caregivers' perception of medical care systems and their stress responses throughout their stay with preschoolers at a pediatric emergency department (ED). Overall, 201 preschoolers' caregivers in pediatric ED were recruited in this study. They were asked to answer self-made questionnaires regarding the perception of medical care systems and their stress responses immediately before preschoolers' release. The results show that caregivers with a low education or low income level were prone to exhibit greater appreciation for the efficiency of medical care systems and greater degree of anxiety for their lack of treatment and care knowledge than those of caregivers with a high education or high income level. Interestingly, caregivers older than 38 years reported greater emotional responses and physical exhaustion than did younger caregivers. Immigrant caregivers had higher emotional reaction and lower concentration than did Taiwanese caregivers. Paradoxically, caregivers undergoing over 3-time pediatric ED visits for observation expressed stronger stress reactions as compared with caregivers with less observation experiences. Not surprisingly, caregivers reported the highest emotional responses when their preschoolers were diagnosed as having very urgent degree in triage classification. Finally, caregivers' perception of "lack of family support" and "lack of treatment and care knowledge" correlated positively with all aspects of the stress responses. These results indicate that attention should be paid to the specific psychological weakness and need for the caregivers with certain demographic characteristics by the medical team in pediatric ED.

Effectiveness of a five-level Paediatric Triage System: an analysis of resource utilisation in the emergency department in Taiwan

ObjectivesTo examine the effectiveness of a five-level Paediatric Triage and Acuity System (Ped-TTAS) by comparing the reliability of patient prioritisation and resource utilisation with the four-level Paediatric Taiwan Triage System...

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

ObjectiveTo investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians' (EPs) subjective reasoning and senior EPs' objective evaluation.DesignThis was a...

Quality of care of patients presenting with acute coronary syndrome in emergency departments in Taiwan

Acute coronary syndrome (ACS) represents one of the most common causes of acute medical admission at Taiwan hospitals. Clinical practice guidelines have been developed to provide physicians with evidence-based approaches to the patient’s daily care. However, data have suggested the presence of a large widespread gap between the medical care provided and the evidence-based recommendations. This report should help us to understand the management of ACS in emergency departments based on quality of care indicators and adherence to recommended practice behaviors and international guidelines in Taiwan. A retrospective patient chart review was undertaken in 14 participating hospitals from July 1, 2006 to June 30, 2007. A random sample of 2388 patients treated at the emergency rooms of these hospitals with the discharge code of ACS was identified. The data captured included final diagnosis, the acute therapies used, the in-hospital revascularization procedures used and the time to initiation of the various procedures. Among the 2388 patients sampled, the mean age was 66.4 years old of which 67.9% were male. Overall, 42.0% of the patients had a history of coronary artery disease (CAD) including 17.0% with a prior myocardial infarction, 23.0% with a prior percutaneous coronary intervention, and 5.5% who had had a prior coronary artery bypass graft. Final diagnoses reported consisted of 29% (n = 701) with ST segment elevation myocardial infarction (STEMI), 30% (n = 718) with unstable angina, 24% (n = 578) with nonSTEMI, 14% (n = 335) with CAD/stable angina and 2.3% (n = 56) with another diagnosis. Out of all STEMI patients, 77.5% (n = 543) received early catheterization and only 4.7% (33/701) were given thrombolytic agent treatment. In addition, among STEMI patients who received an early interventional strategy, only 41.7% received urgent cardiac catheterization within 90 minutes. The average time until a 12-lead electrocardiogram was obtained was 20.6 minutes, and only 52% of the patients had the electrocardiogram completed within 10.0 minutes. Only 42% of patients who underwent an interventional strategy had catheterization intervention within 90 minutes after arriving at the emergency room. There were significant variations in practice between hospital types and across geographic areas. Further stricter implementation of the guidelines is needed to improve the quality of care provided to Taiwanese ACS patients.

Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department: A retrospective study in a tertiary Referral Center

Approximately two-thirds of the patients with severe sepsis or septic shock are first encountered in the emergency departments (EDs) of western countries, in which bacteremia is present in about 50% of patients with severe sepsis. The situation of bacteremia presenting to the EDs in Taiwan is not well documented. The objective of this study was to examine the epidemiology and microbiology of bacteremia in adult patients who visited the ED of a medical center in southern Taiwan. A retrospective observational study of the epidemiology and microbiology of bacteremia was conducted in the ED of a medical center involving 6,137 adult patients and 13,903 blood cultures. A total of 831 consecutive patients with 890 episodes of bacteremia were obtained from January 1 to December 31, 2004, indicating a positive culture rate of 13.5% (1,872/13,903). Among these episodes, 525 (59%) were defined as true community-acquired infections followed by 263 (29.5%) as health care-associated infections and 102 (11.5%) as nosocomial infections. Of the 972 isolates, 289 (29.7%) were gram-positive species and 683 (70.3%) were gram-negative species. Urinary tract infections (32.2%, 287/890) were most common in these patients, with Escherichia coli (30.8%, 299/972) being the most common pathogen. Bacteremia caused by Staphylococcus aureus was more common in nosocomial than true community-acquired infections (31.3% vs. 12%) and had significantly higher possibility of resistance to methicillin in infections not purely acquired from community (odds ratio = 24.92; 95% confidence interval, 9.88-62.87). The overall crude mortality rate was 21% and nearly half of the mortalities occurred within 3 days of visiting the ED. All patients discharged inadvertently were uneventful (n = 65, two lost at follow-up). Categories of bacteremia acquisition was associated with different distribution of pathogens, antimicrobial resistance, and clinical outcome. Traditional classification might overestimate the problem of drug resistance in community-acquired infections. The concept of health care-associated infection should be introduced to avoid overemphasis of drug-resistant problem in true community-acquired infection.

The nursing experience of a patient with acute paraquat poisoning in the emergency department in Taiwan: A case study

In today’s Emergency Departments (EDs), there are coninued expectations placed on clinicians to manage an ncreasing number of patient presentations in an environent of fluctuating staffing levels and varied degrees of linical skills. Each of these factors combines to result in elays to treatment and variation in the delivery of the atient care, which further impacts on patient outcomes nd experiences. In an effort to reduce identified delays to patient treatent and variations in patient care, the Australian Capital erritory (ACT) Emergency Care Network has developed number of symptom based outcome focussed standard perating protocols (SOPs). These SOPs are descriptive, mulidisciplinary, practical guides, developed through evidence nd expert opinion. Each protocol has clear inclusion and xclusion criteria to guide junior and/or less experienced linicians with the structure to initiate best practice care in timely fashion or to make sound decisions regarding when o refer more complex patients to senior clinicians. Given there are two EDs in the ACT, the protocols have een developed with each EDs local service requirements in ind whilst recognising the need for a consistent approach in he development of education packages and in the process f initiating the use of the protocols. Consistency in proesses is paramount to the successful implementation and wnership of the protocols, which will ensure a standard of uality care between organisations to support comparative valuation and optimal patient outcomes.

Etiology and outcome of patients presenting for poisoning to the emergency department in Taiwan: a prospective study

Poisoning is one of the most common reasons for visiting the emergency department in many countries, and the pattern varies from countries to countries and time to time. To compare the etiology and outcome of poisoning patients in different gender and age groups, we conducted a prospective study at the emergency departments of two medical centers in southern Taiwan between January 2001 and December 2002. All cases of poisoning, excluding patients diagnosed as cases of alcohol or food poisoning, were included, and relevant information was collected. There were 1512 cases of poisoning observed with a male to female ratio of 1:1.2 (684/828). Overall, drugs (49.9%) were the main agents involved, and a suicidal attempt (66.1%) was the predominant etiology. A total of 63 fatalities (4.2%) were observed and pesticides, especially paraquat, resulted in most fatalities. Patients aged 19-30 years constituted the most cases, and significant differences in exposure agents, causes, and fatality rates were found among different age and gender groups. The results are compatible with the trend reported by other Asian countries. This study also shows important differences existing in poisoning patients of different age and gender groups. Therefore, different poisoning-prevention strategies should be applied to different groups.

Physician and nurse job climates in hospital-based emergency departments in Taiwan: management and implications.

This study evaluates how emergency physicians and nurses perceive their job climates in their hospital-based emergency departments (ED). In total, 208 emergency physicians and 234 emergency nurses were surveyed, applying a validated survey instrument covering the job facets of medical and nursing autonomy, professional accomplishments and outcomes, leadership, communication, management, hospital policies and regulations, and external health policy environments germane to emergency medicine. The findings reveal that the average satisfaction score for professional growth and accomplishments was ranked highest by emergency physicians, and job communication within EDs was ranked highest by emergency nurses. Several emergency medical professional characteristics, including age, education, medical authority, employment duration, full-time or part-time statuses, perceived workloads, and hospital accreditation levels, were all related to job satisfaction in this surveyed population. New insights generated from this study could provide increased guidance to hospital and ED unit managers toward enhancing wellness and limiting dissatisfaction and disharmony relative to long-term career survival and the well-being of ED specialists.

A project using discharge telephone follow-up, decreases unplanned revisits to the emergency department in Taiwan

A project using discharge telephone follow-up, decreases unplanned revisits to the emergency department in Taiwan

The nursing experience of a patient with adenocarcinoma of the lung in the terminal stage waiting for a bed in the emergency department in Taiwan: A case study

The nursing experience of a patient with adenocarcinoma of the lung in the terminal stage waiting for a bed in the emergency department in Taiwan: A case study

The Impact of the SARS Outbreak on an Urban Emergency Department in Taiwan

Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. The patients' characteristics in an urban ED were collected from March to May 2003 during the SARS outbreak in Taiwan. The crisis period was divided into 2 periods: 30 days before (period 1) and after (period 2) April 21, the date of the first hospital-associated transmission. Problem severity in the ED and stress levels of ED staff during the SARS catastrophe were rated from mild (1 point) to severe (5 points). The number of ED patients declined 33.4% in period 2. There was a 2.1% (95%CI, 0.4-3.8) increase in the percentage of male patients, a 2.5% (95% CI, 1.5-3.7) increase in percentage of fever (>38 degrees C), and a 4.0% (95% CI, 2.6-5.4%) increase in chief complaint of fever in period 2. The number of nontrauma patients younger than 18 years had declined by 44.5% in period 2. The total charge for reimbursement from an insurance institution declined 21.7%. During the SARS outbreak, the most severe stress experienced by either physicians or nurses occurred during emergency resuscitation (median stress rating point, 4; interquartile range, 1). The SARS catastrophe affected the ED visit volume, finances, various patient characteristics, and stress levels in the ED physicians and nurses. EDs must be fully prepared to face the challenges of the next outbreak of SARS or other infectious disease.

Six Years Experience with Telemedicine in an Emergency Department in Taiwan

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ED overcrowding in Taiwan: Facts and strategies

The objective of this study was to quantity the extent of emergency department (ED) overcrowding in Taiwan and to identify possible solutions. The ED log was reviewed for all patients who presented to the National Taiwan University Hospital's ED from January 16, 1996 through February 15, 1996. Charts from patients held longer than 72 hours were reviewed. Among 5,810 patients, 213 (3.6%) were held in the ED for more than 72 hours (7.1 patients per day). In 149 (70.0%) of them, admission was indicated but delayed (42 because more than one subspecialty were involved, 57 because of unavailability of bed, and 50 because of the disparity in admission priority between the emergency physicians and house staffs). Eighteen (8.4%) patients did not meet admission criteria (13 could have been treated in outpatient clinics, 3 needed placement in nursing homes, 2 because of personal problems). The others (22%) recovered while waiting. Significant overcrowding exists in EDs in Taiwan. Four solutions are proposed: (1) creation of a holding unit; (2) flexible ward assignment; (3) pre-established rules for admission priority-setting; and (4) active interfacility transfer. Only through these efforts can EDs in Taiwan guarantee an optimal level of care in the face of a growing patient demand.