Emergency Department Of Tertiary Hospital Research Articles

Patients with palliative needs in a tertiary hospital emergency department in 2021 - retrospective chart review

Introduction: Children with complex chronic diseases and life-limiting conditions require a differentiated and adapted medical approach. OBJECTIVES: Characterise the affluence and management of children, followed by an in-hospital pediatric palliative care support team, who presented to a tertiary hospital pediatric emergency department in 2021. Methods: A one-year retrospective analysis of emergency episodes was performed by consulting medical records. Episodes were categorized, data were recorded anonymously, and descriptive statistical analysis was carried out. Results: Of the 58 pediatric patients monitored by the team, 66% resorted to the emergency department in 2021, leading to 85 admissions (average: two per patient; 82% classified as urgent, very urgent, or immediate). The most frequent admission reasons were respiratory symptoms. Hospitalization was required in 45%: 3 patients transferred from another hospital in the pediatric intensive care unit, 32 to the pediatric ward, and the remaining in the observation service. Blood tests, cultures and imaging tests were performed in 45%, 48% and 46% respectively, and antibiotics instituted in 44%. Twenty-three children (61%) admitted to the emergency department had an orally discussed advanced care plan. No patients died in the emergency department or the intensive care unit. One died at home with support from the team and three in the ward. Discussion: The reduced emergency department visits per patient and the frequent hospitalization needed when recurring reflects the effectiveness of a differentiated multidisciplinary team, domiciliary care and caregiver training. Establishing an advanced care plan and an emergency approach protocol is fundamental for individualized care delivery.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16–18: a retrospective cross-sectional study

BackgroundA recent study conducted at our tertiary hospital emergency department (ED) reviewed ED consultations and found that adolescents aged 16–18 years present significantly more often for trauma and psychiatric problems than adults over 18 years. Accidental injuries are one of the greatest health risks for children and adolescents. In view of the increased vulnerability of the adolescent population, this study aimed to further analyse trauma-related presentations in adolescents.MethodsWe conducted a single-centre, retrospective, cross-sectional study of all adolescent trauma patients aged 16 to 18 years presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from January 2013 to July 2017. We analysed presentation data as well as inpatient treatment and cost-related data. Data of female and male patients were compared by univariable analysis. A comparison group was formed consisting of 200 randomly chosen patients aged 19–25 years old with the same presentation characteristics. Predictive factors for surgical treatment were obtained by multivariable analysis.ResultsThe study population included a total of 1,626 adolescent patients aged 16–18 years. The predominant causes for ED presentation were consistent within case and comparison groups for sex and age and were sports accidents, falls and violence. Male patients were more likely to need surgical treatment (OR 1.8 [95% CI: 1.2–2.5], p = 0.001) and consequently inpatient treatment (OR 1.5 [95% CI: 1.1–2.1], p = 0.01), associated with higher costs (median 792 Swiss francs [IQR: 491-1,598]). Other independent risk factors for surgical treatment were violence-related visits (OR 2.1 [95% CI: 1.3–3.5, p = 0.004]) and trauma to the upper extremities (OR 2.02 [95% CI: 1.5–2.8], p < 0.001). Night shift (OR 0.56 [95% CI: 0.37–0.86], 0.008) and walk-in consultations (OR 0.3 [95% CI: 0.2; 0.4, < 0.001] were preventive factors for surgical treatment.ConclusionsMale adolescents account for the majority of emergency visits and appear to be at higher risk for accidents as well as for surgical treatment and/or inpatient admission due to sports accidents or injuries from violence. We suggest that further preventive measures and recommendations should be implemented and that these should focus on sport activities and injuries from violence.

Performance of ECG-Derived Digital Biomarker for Screening Coronary Occlusion in Resuscitated Out-of-Hospital Cardiac Arrest Patients: A Comparative Study between Artificial Intelligence and a Group of Experts.

Acute coronary syndrome is a significant part of cardiac etiology contributing to out-of-hospital cardiac arrest (OHCA), and immediate coronary angiography has been proposed to improve survival. This study evaluated the effectiveness of an AI algorithm in diagnosing near-total or total occlusion of coronary arteries in OHCA patients who regained spontaneous circulation. Conducted from 1 July 2019 to 30 June 2022 at a tertiary university hospital emergency department, it involved 82 OHCA patients, with 58 qualifying after exclusions. The AI used was the Quantitative ECG (QCG™) system, which provides a STEMI diagnostic score ranging from 0 to 100. The QCG score's diagnostic performance was compared to assessments by two emergency physicians and three cardiologists. Among the patients, coronary occlusion was identified in 24. The QCG score showed a significant difference between occlusion and non-occlusion groups, with the former scoring higher. The QCG biomarker had an area under the curve (AUC) of 0.770, outperforming the expert group's AUC of 0.676. It demonstrated 70.8% sensitivity and 79.4% specificity. These findings suggest that the AI-based ECG biomarker could predict coronary occlusion in resuscitated OHCA patients, and it was non-inferior to the consensus of the expert group.

The Relationship between Patient Load and Nursing Staffing Strength in Various Shifts of the Day in Emergency Department of a Major Tertiary Care Hospital in India

Abstract Introduction A hospital has to function 24 hours a day, which makes shift duties almost inescapable for the nurses. However, shift wise staffing of nursing in emergency departments (EDs) of most hospitals continues to parallel that of other clinical departments. Objective The aim of this study was to see the adequacy of staffing in reference to patient load in the different shifts of the day in the ED of a major tertiary care hospital in India. Methods This is a prospective cross-sectional study. The number of patients entering the ED in each shift as well as the number of nurses assigned in each shift were taken from the rotation over a period of 1 week. A single point questionnaire was also administered to all five nurses in each shift over the study period to assess staff perception of patient load in the shift. Ethics approval was taken from institutional ethics committee. Results For calculating the differential patient load in different shifts. We have calculated the average number of registered patients entering the emergency in over 1 week was 24 in the morning shift, 24 in the evening shift, and 81 in the night shift. The average nursing strength was 11 in morning shift, 11 in the evening shift, and 10 in the night shift. The average response from 15 nurses after interviewing them was 1 (overstaffed) in the morning, 2 (properly staffed) in the evening shift (properly staffed), and 4 in the night shift. Conclusion The ratio of registered patients entering the emergency and the number of nurses deployed in each shift does not match, which gives an important view to revise roster in such a way that will not compromise the patient care.

Mapping clinical interactions in an Australian tertiary hospital emergency department for patients presenting with risk of suicide or self-harm: Network modeling from observational data.

Reliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians face the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment, and referral decisions. Patient outcomes therefore depend on the reliable flow of information through networks of clinical staff and information systems. This study aimed to develop a quantitative data-driven research framework for the analysis of information flow in emergency healthcare settings to evaluate clinical practice and operational models for emergency psychiatric care. We deployed 2 observers in a tertiary hospital emergency department during 2018 for a total of 118.5 h to record clinical interactions along patient trajectories for presentations with risk of self-harm or suicide (n = 272 interactions for n = 43 patient trajectories). The study population was reflective of a naturalistic sample of patients presenting to a tertiary emergency department in a metropolitan Australian city. Using the observational data, we constructed a clinical interaction network to model the flow of clinical information at a systems level. Community detection via modularity maximization revealed communities in the network closely aligned with the underlying clinical team structure. The Psychiatric Liaison Nurse (PLN) was identified as the most important agent in the network as quantified by node degree, closeness centrality, and betweenness centrality. Betweenness centrality of the PLN was significantly higher than expected by chance (>95th percentile compared with randomly shuffled networks) and removing the PLN from the network reduced both the global efficiency of the model and the closeness centrality of all doctors. This indicated a potential vulnerability in the system that could negatively impact patient care if the function of the PLN was compromised. We developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams using greedy cumulative addition of network edges in the model. Finally, we identified specific interactions along patient trajectories which were most likely to precipitate a psychiatric referral using a machine learning model trained on features from dynamically constructed clinical interaction networks. The main limitation of this study is the use of nonclinical information only (i.e., modeling is based on timing of interactions and agents involved, but not the content or quantity of information transferred during interactions). This study demonstrates a data-driven research framework, new to the best of our knowledge, to assess and reinforce important information pathways that guide clinical decision processes and provide complementary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm. Our findings suggest that PLNs can play a crucial role in clinical communication, but overreliance on PLNs may pose risks to reliable information flow. Operational models that utilize PLNs may be made more robust to these risks by improving interdisciplinary communication between doctors. Our research framework could also be applied more broadly to investigate service delivery in different healthcare settings or for other medical specialties, patient groups, or demographics.

Perceived Causes and Effects of Overcrowding Among Nurses in the Emergency Departments of Tertiary Hospitals: A Multicenter Study.

Emergency department (ED) overcrowding is a significant concern in many hospitals in Saudi Arabia, resulting in long waiting times, delays in treating patients who need urgent care, and, consequently, decreased patient satisfaction. Additionally, ED overcrowding has been linked to increased nurse turnover rates. Therefore, this study aimed to assess nurses' perceived causes and effects of overcrowding in the EDs of five tertiary hospitals in Saudi Arabia. This study used a descriptive cross-sectional design. We surveyed 311 nurses working in the EDs of five tertiary hospitals in Saudi Arabia using the convenience sampling technique. The self-administered questionnaires used in the study were developed by the researchers. The study was conducted from October 16 to November 10, 2022. Consensus-Based Checklist for Reporting of Survey Studies was followed. The results revealed that the primary perceived causes of ED overcrowding in five tertiary hospitals were unnecessary visits due to a lack of standard procedures (mean = 2.70; SD = 0.58) and lack of inpatients beds (mean = 2.69; SD = 0.65). The perceived effect of overcrowding was stress and burnout among nurses (mean = 2.85; SD = 0.47). The perceived causes and effects of overcrowding in the ED were found to be highly significant (p <0.001) based on Pearson correlation and Spearman's rank correlation. Unnecessary visits due to a lack of standard procedures lead to overcrowding. In addition, a lack of inpatient beds in the ED affects the care provided to patients seeking immediate medical attention. This may prolong patient waiting time, causing their conditions to deteriorate and prolonging hospital stay. Overcrowding leads to increased stress and burnout among nurses. The results of this study can be used to develop a comprehensive action plan to address ED overcrowding and its effects on patients, staff, and ED flow.

Presentations patterns of acute onset binocular diplopia among paediatric population in the emergency department: Retrospective analysis and systematic review of the literature

Aims/Purpose: This study aims to analyse the available evidence to identify the presentation patterns and underlying etiologies among paediatric patients presenting with acute onset binocular diplopia (AOBD) in the emergency department (ED).Methods: A longitudinal retrospective analysis of medical records from paediatric patients, younger than 21 years old, presenting with AOBD in a tertiary hospital's ED. All patients were followed until a final diagnosis was made. Emergent conditions (ECs) were defined as those reflecting significant neurologic abnormalities or requiring further investigations or interventions. In addition, a comprehensive systematic review of the literature was performed, which was conducted in accordance with the PRISMA guidelines. The search included 2 databases (PubMed and Google Scholar) and was completed on May 1st 2023.The search terms included (paediatric) AND (diplopia) AND (emergency).Results: During the 10‐years study period, of overall 745 patients admitted to ED with AOBD, 62 were children. Accounting for 8.36% of all the visits. Our population consisted of 27 females (43.54%) and 35 (56.45%) males. The mean age was 9.87 years (±4.83). 62 (retrospective analysis) and 590 patients (systematic review), met the inclusion criteria. The majority of the patients had non‐ECs, incidence between 60 and 80%. Among ECs, central nervous system tumours and demyelinating conditions were the most common diagnoses. Although not all the patients with ECs presented with associated sings (54%), most of the patients exhibiting associated signs were found to have an underlying EC.Conclusions: Most cases of diplopia in children admitted to the ED had non‐ECs underlying conditions. The literature indicates a statistically significant relationship between the presence of associated neurologic signs and ECs.

Health care utilisation of asylum seekers and refugees in the South-West of Germany.

Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters. In a retrospective cohort study design, using medical records, we followed inhabitants of a reception centre in Germany between 11.10.2015 and 30.05.2018. We assessed frequency of visits and revisits to a newly established integrated care facility (ICF), and the effects of the ICF on visits to the local emergency department (LED) in the regional tertiary hospital using survival analysis and time series regression. We also explore the influence of operational parameters on the different implementation phases; phase 1: provisional clinic with 1-2 hours of physician presence daily, phase 2: implementation of ICF with 2-4 hours of care by a team of doctors and nurses daily, phase 3: routine running of ICF with daily operational hours of 10am-2pm with care provided by an interdisciplinary team of doctors and nurses. 14,419 total medical visits were recorded from 1,883 persons seeking health care in the ICF. The absolute number of visits per day remained similar over the study period (19·9/day), yet the relative number of visits changed from 2·2 to 15 per 100 inhabitants from phase 2 to 3, respectively. Most visits were due to respiratory infections (612/3080, 20%), and trauma and musculoskeletal conditions (441/3080, 14%). The rate of revisits to ICF was 2·9 per person per month (95%CI 2·9-3), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0·3/100 inhabitants per day to 0·14/100 inhabitants after implementation of the ICF and back to 0·3/100 inhabitants during the routine running. Though seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. While visits to the LED decreased after the implementation of the ICF, visits returned to the pre-ICF levels during the routine running of the ICF. The results show that AS&R require reliable access to health care, yet the needs of specific groups of migrants may be different, especially those with language barriers, minority groups or those from certain regions. As such, care should be migrant sensitive and adapt to the changing needs of the population. Though more research is required to better understand the differing needs of migrants, this study may help to inform guidelines surrounding migrant sensitive standards of care in Germany.

Potential drug-drug interactions between discharge medication from the emergency department and home medication in tertiary hospital

Objective: This retrospective analysis aimed to comprehensively examine the age distribution, gender prevalence, comorbidity patterns, and potential drug-drug interactions among discharged emergency department (ED) patients. By elucidating these factors, the study would contribute valuable insights for improving patient care and medication safety. Methods: The study used retrospective data collection and analyzed cross-sectional data of patients discharged from the ED at King Abdullah Medical City from January to February 2023. Results: The results showed that the majority of discharged patients were between the ages of 36 and 50 years (56.4%) and had a balanced gender distribution. The most common department of discharge was cardiology (42.1%). The analysis also revealed that 68.5% of patients had 3 to 6 comorbidities. The study found significant associations between discharge status and potential drug-drug interactions (DDIs), with patients discharged against medical advice having a higher incidence of potential DDIs (p = 0.037). Conclusion: The study highlighted the importance of training emergency physicians to use hospital systems to identify and prevent potential DDIs. The prevalence of DDIs between prescribed ED medication and home medication was found to be high. The study suggested that discharge status and DDI severity are significant factors influencing the frequency of potential DDIs.

Acute poisoning cases admitted to a tertiary hospital emergency department: A Prospective and Discriptive Study

Introduction&#x0D; Acute poisoning, characterized by exposure to toxic substances for less than 24 hours, is a significant public health issue worldwide. Factors leading to poisoning vary by region, customs, and socioeconomic level. To prevent this, countries and regions should analyze etiological and demographic characteristics of poisoning and take precautions. This study aimed to determine demographic, etiologic, and clinical characteristics of acute poisoning cases.&#x0D; Material and Method&#x0D; The study analyzed sociodemographic factors, clinical outcomes, and the causes of poisoning. Patients who attempted suicide were consulted by psychiatry at the end of their follow-up. The data was analyzed using Windows SPSS 21.0, with p

Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)

Objective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern.&#x0D; Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P&lt;0.05) associated with the month of the year and day of the week.&#x0D; Results: A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P&lt;0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October. It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. &#x0D; Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED.

Evaluating Clinical Prediction Rules for Bacteremia Detection in the Emergency Department: A Retrospective Review

BackgroundBacteremia is a major cause of morbidity. Blood cultures are the gold standard for diagnosing bacteremia. ObjectiveTo compare previously published clinical decision rules for predicting a true positive blood culture (bacteremia) in the emergency department. MethodsRetrospective analysis of medical records of patients who had a blood culture performed in a tertiary hospital emergency department in 2020 (12 months). Positive blood cultures were compared with randomly selected negative blood cultures (1:4 ratio). Blood cultures were analyzed per patient presentation. Clinical data from patient presentations were extracted and appraised against the modified-Shapiro (mShapiro) rule and systemic inflammatory response syndrome (SIRS) criteria to calculate diagnostic accuracy to detect bacteremia. ResultsDuring the study period, 3870 blood cultures were taken from 2921 patients: 476 (12.3%) cultures were positive for bacterial growth, from 421 individual patient presentations (10 excluded as incomplete data). Of included patients, 338 were true positives and 73 contaminates, these were compared with 1446 patients with negative blood culture presentations. Evaluating mShapiro's rule and SIRS criteria to detect bacteremia vs. no bacteremia (negative + contaminated cultures) had a sensitivity of 94.4% (95% confidence interval [CI] 91.4–96.4%) and 84.9% (95% CI 80.7–88.3%), respectively, and a specificity of 37.9% (95% CI 35.5–40.1%) and 33.8% (95% CI 31.5–36.3%), respectively. Both had a high negative predictive value for bacteremia of 96.8% (95% CI 95.1–98.0) and 91.0% (95% CI 88.3–93.1) for mShapiro's rule and SIRS criteria, respectively. ConclusionsIn this cohort, mShapiro's rule performed better than the SIRS criteria at predicting bacteremia.

Clinical and economic impact of partnered pharmacist medication charting in the emergency department.

Introduction: Partnered pharmacist medication charting (PPMC), a process redesign hypothesised to improve medication safety and interdisciplinary collaboration, was trialed in a tertiary hospital's emergency department (ED). Objective: To evaluate the health-related impact and economic benefit of PPMC. Methods: A pragmatic, controlled study compared PPMC to usual care in the ED. PPMC included a pharmacist-documented best-possible medication history (BPMH), followed by a clinical conversation between a pharmacist and a medical officer to jointly develop a treatment plan and chart medications. Usual care included medical officer-led traditional medication charting in the ED, without a pharmacist-obtained BPMH or clinical conversation. Outcome measures, assessed after propensity score matching, were length of hospital or ED stay, relative stay index (RSI), in-hospital mortality, 30-day hospital readmissions or ED revisits, and cost. Results: A total of 309 matched pairs were analysed. The median RSI was reduced by 15.4% with PPMC (p = 0.029). There were no significant differences between the groups in the median length of ED stay (8 vs. 10h, p = 0.52), in-hospital mortality (1.3% vs. 1.3%, p > 0.99), 30-day readmission rates (21% vs. 17%; p = 0.35) and 30-day ED revisit rates (21% vs. 19%; p = 0.68). The hospital spent approximately $138.4 for the cost of PPMC care per patient to avert at least one medication error bearing high/extreme risk. PPMC saved approximately $1269 on the average cost of each admission. Conclusion: Implementing the ED-based PPMC model was associated with a significantly reduced RSI and admission costs, but did not affect clinical outcomes, noting that there was an additional focus on medication reconciliation in the usual care group relative to current practice at our study site.

Perceived organizational support, self-efficacy and cognitive reappraisal on resilience in emergency nurses who sustained workplace violence: A mediation analysis.

The aims of this study were as follows: (a) to examine the relationship between perceived organizational support and resilience; (b) to investigate the potential mediating role of general self-efficacy and cognitive reappraisal among emergency nurses who have experienced workplace violence; and (c) to explore the application of Kumpfer's resilience framework to emergency department nurses. A cross-sectional study. From February 17, 2021, to March 8, 2021, 825 emergency nurses working in the emergency departments of tertiary hospitals in Shanghai, China, completed an online survey. Data on resilience, organizational support, cognitive reappraisal and general self-efficacy were collected through questionnaires. The Spearman analysis was employed to investigate the relationship between variables, while the mediation analysis was conducted using AMOS 23.0 statistical software. The findings of a study involving 825 emergency nurses who reported experiencing workplace violence reveal a positive correlation between perceived organizational support and resilience. Additionally, it has been observed that the relationship between these two factors is mediated by both cognitive reappraisal and general self-efficacy. Furthermore, the mediating effect of cognitive reappraisal is more significant in this relationship. Kumpfer's resilience framework is found to apply to emergency nurses. Perceived organizational support, an environmental factor, affects resilience directly and positively. In addition, cognitive reappraisal and general self-efficacy, which are individual factors, mediate this influence path. These findings suggest an interaction between environmental and individual factors in determining the resilience of emergency nurses. These findings have implications for developing resilience intervention strategies for emergency nurses exposed to occupational violence. Enhancing personal attributes such as general self-efficacy and cognitive reappraisal is as significant as strengthening external organizational support environments for enhancing nurses' resilience. Emergency nurses participated in the pilot test of our questionnaire survey and gave their opinions on the questionnaire design. What is already known about the topic? In emergency rooms, workplace violence is prevalent, and it seriously endangers nurses' physical and mental health. Enhancing resilience can improve nurses' ability to self-regulate after experiencing violence. However, the drivers and mechanisms of resilience among emergency nurses who have experienced workplace violence remain unidentified. What this paper adds? This study confirms the applicability of Kumpfer's resilience framework to emergency nurses who have experienced workplace violence. Nurses' self-efficacy and cognitive reappraisal mediate the relationship between perceived organizational support and resilience after exposure to workplace violence. The resilience process for emergency nurses involves the interaction of individual and environmental factors. Implications for practice/policy. Managers and researchers should consider the interaction between individual and environmental factors when developing resilience intervention strategies for emergency nurses who have suffered workplace violence. It is essential to support emergency nurses from the dyadic dimensions of the environment and the individual. A supportive organizational environment and individual positive adjustment strategies are equally important in promoting resilience among nurses.

Early rule-out of major adverse cardiac events in acute chest pain patients using a risk score and self-reported computerised history taking

Abstract Introduction Risk scores, such as the History, ECG, Age, Risk factors, and Troponin (HEART) score, Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol (EDACS-ADP), and Troponin-only Manchester Acute Coronary Syndrome (T-MACS), are recommended for the evaluation of acute chest pain patients. Obtaining a structured medical history by self-reported computerised history taking (CHT) may provide an automated and improved risk assessment in the emergency department (ED). Purpose We aimed to determine the diagnostic accuracy of three well-established acute chest pain risk scores using CHT to predict 30-day major adverse cardiovascular event (MACE). Methods Prospective cohort of clinically stable patients aged ≥18 years presenting with a chief complaint of chest pain and an ECG not indicating an acute coronary syndrome (ACS), at a tertiary hospital ED during 2017–2019. Medical histories were self-reported on a tablet using a CHT program (Clinical Expert Operating System, CLEOS), owned by a public university. With &amp;gt;17,000 decision nodes, CLEOS mimics a physician interview and tailors each interview depending on previous answers. Data acquired is in a binary structured format and can be used for input in clinical decision support systems. The HEART score, EDACS-ADP, and T-MACS were calculated from the CHT and the electronic health records (EHR). Relevant EHR data, including medical history, vital signs, and lab data, was extracted manually by the research staff in a predetermined standardised way. The EHR was subsequently reviewed for ACS and intervention procedure International Classification of Diseases (ICD) codes for any 30-day 3-point MACE. Results Of the 1,000 consecutive participants enrolled (mean age 55±17 years; 54% women), the HEART score, EDACS-ADP, and T-MACS could be calculated in 65%, 65% and 68%, respectively using only CHT acquired data. Main reasons for premature termination of the CHT were early discharge from ED or getting tired. A 30-day MACE occurred in 7.2% of the total population. The sensitivity, specificity, positive and negative predictive values of any 30-day MACE are presented in Table 1. The diagnostic accuracy for each risk score using CHT was similar to previous studies, where physician-collected data was used. Conclusions CHT can provide relevant risk scores in a majority of acute chest pain patients, and allow a safe and early rule-out of a 30-day MACE. The use of CHT may enable automation and improve the management of a large proportion of low-risk acute chest pain patients in the ED.Example of a question in the CHT program

Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial

BackgroundPeripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty. ObjectiveThis study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas. MethodsWe conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study—pain experienced by patients and procedural difficulties experienced by clinical staff—were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires. ResultsData from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56–1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66–0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively. ConclusionsThere was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.

Profile of pediatric ophthalmic referrals in a single emergency department in Korea

Purpose: This study was performed to examine a comprehensive profile of ophthalmic (OPH) referrals based on diagnosis in a single emergency department (ED) in Korea.Methods: We analyzed the clinical profiles of children (&lt; 18 years) who underwent immediate OPH referrals in a tertiary hospital ED, from March 2013 through December 2022. Exclusion criteria were a visit related to procedural complication and a discharge before thorough evaluation. We focused on a diagnosis-based high OPH severity requiring emergency surgery or hospitalization. The profiles were compared according to the severity and age group (0-3, 4-6, 7-12, and 13-17 years).Results: A total of 1,939 children consisted of 1,281 (66.1%) with injury and 658 (33.9%) with non-injury. Top 3 injuries were orbital fracture, hyphema, and corneal abrasion, whereas top 3 non-injuries were keratoconjunctivitis, cellulitis, and hordeolum. Children with high OPH severity (54.5%) had significantly lower proportions of girls (26.5% vs. 38.9%), visits on weekend/holiday (34.4% vs. 43.4%), and most non-injury chief complaints, and higher proportions of 13-17 years (41.1% vs. 23.6%), injury (87.7% vs. 40.1%), emergency surgery (4.9% vs. 0.1%), in-ED procedure (9.3% vs. 2.4%), hospitalization (4.0% vs. 0.8%), and most injury mechanisms. With increasing age, high OPH severity, orbital fracture, and hyphema increased in proportions, in contrast to a decreasing tendency in corneal abrasion, keratoconjunctivitis, cellulitis, and hordeolum (all Ps for trend ≤ 0.001). There were 610 (31.5%) children with low OPH severity or no OPH diagnosis.Conclusion: True OPH emergencies may be more common in injured, older, or male children. This finding could be useful in focusing on emergencies while diverting less urgent cases to outpatient departments or outside ophthalmology clinics.

Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study

ObjectiveDo-not-attempt-resuscitation (DNAR) orders are designed to allow patients to opt out of receiving cardiopulmonary resuscitation in the event of a cardiac arrest. While DNAR has become a standard component of...

Diagnostic accuracy of plasma brain natriuretic peptide for evaluation of dyspnea NYHA-III and NYHA-IV in emergency department of tertiary care hospital.

To determine the diagnostic accuracy of breathing not properly (BNP) for evaluation of dyspnea NYHA III and IV due to systolic heart failure in emergency department patients keeping echocardiography as the gold standard. Cross-sectional validation study. Setting: Department of Accident and Emergency Duration of Study: 25 July 2022-25 January 2023. A total of 115 of both sexes presenting with acute onset of dyspnea and having NYHA Class III and IV were included. Emergency nursing staff had immediately taken a single venous blood sample for BNP and creatinine levels and a 2D echo was performed. Ejection fraction was recorded, and the diagnosis of systolic heart failure on the basis of an ejection fraction, that is less than or equal to 45% was documented. The age range in this study was from 18 to 65 years, with a mean age of 49.147±8.73 years. Mean BNP levels were 139.452±84.04pg/ml. Patients with NYHA class III was 67.8 and 32.2% belongs to NYHA class IV. BNP levels greater than or equal to 100pg/ml diagnosed 76 (66.1%) and echocardiography has diagnosed 68 (59.1%) patients with heart failure. BNP levels greater than or equal to 100pg/ml had shown sensitivity 94.1%, specificity 74.5%, and diagnostic accuracy 86%, positive predictive value 84.21%, negative prediction value 89.74%, likelihood positive ratio 3.68 and likelihood negative ratio was 0.08 in diagnosis of heart failure. BNP estimation is a sensible and particular procedure for diagnosing CHF in patients who present to the emergency department with acute dyspnea and may add extra advantages to the administration of patients with congestive heart failure (CHF) in our population.