Patients In Emergency Service Research Articles

Shock Index and Lactate Level as Prognostic Factors of 24-Hour Mortality in Polytraumatized Patients in Emergency Services

Trauma is third in the world in terms of causes of mortality, accounting for 10% of all deaths. It is the primary cause of mortality for most persons under 40 and leads to severe disabilities. In addition, an increasing proportion of senior trauma patients are at increased risk of mortality. Hemorrhage is one of the two main causes of mortality after trauma, with 80% of deaths occurring within 48 hours. As a result, early, individualized treatment and proper triage are critical components of the trauma system, matching resources to the severity of the patient's injuries without overburdening the system. Whether to send a patient to a trauma center is the first choice made during triage 1-4.

An Evaluation on the Attitude Toward Using Patient Rights and Satisfaction Levels in Emergency Department Patients

IntroductionIn emergency health care services, patient satisfaction is one of the fundamental indicators of quality emergency care, making it essential to identify factors that can impact this component of care. This study aimed to determine emergency service patients’ attitudes toward using patient rights, their satisfaction levels with emergency service, and related factors. MethodsThe cross-sectional study was conducted with 382 patients who presented to the emergency department between November 2022 and March 2023. Data were collected using the Patient Description Form, the Emergency Department Patient Satisfaction Scale, and the Scale of Patient Rights Using Attitude. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting. ResultsThe mean score of the Emergency Department Patient Satisfaction Scale was 53.88 ± 6.88 (minimum score, 30; maximum score, 68), and the mean score of the Scale of Patient Rights Using Attitude was 108.89 ± 11.90 (minimum score, 73; maximum score, 135). As a result of the regression analysis, it was found that the Scale of Patient Rights Using Attitude scores and frequency of ED visits significantly contributed to the Emergency Department Patient Satisfaction Scale scores. Younger patients who had higher educational status presented to the emergency department more frequently and had chronic diseases were associated with positive attitudes about using patient rights and had higher levels of ED patient satisfaction (P < .001). DiscussionThe study has provided valuable information for assessing the attitudes of ED patients toward exercising their patient rights and their satisfaction levels. Respect for patient rights and their effective utilization by patients can enhance the quality of ED services and increase patient satisfaction.

Primary admission to a surgical service facilitates early cholecystectomy in acute cholecystitis but does not influence patient outcome

PurposeEarly cholecystectomy is recommended for acute calculous cholecystitis to reduce complications and lower health care costs. However, not all patients admitted to emergency services due to acute calculous cholecystitis are considered for surgery immediately. Our intention was therefore to evaluate patient management and outcome parameters following cholecystectomy depending on the type of emergency service patients are primarily admitted to.MethodsWe performed a retrospective analysis of all patients that were treated for acute cholecystitis at our hospital between 2014 and 2021. Only patients that underwent surgical treatment for acute calculous cholecystitis were included. Patients with cholecystectomies that were performed due to other medical conditions were not incorporated. Primary outcomes were the perioperative length of stay and postoperative complications. Perioperative antimicrobial management and disease deterioration according to Tokyo Guidelines from 2018 due to inhouse organization were assessed as secondary outcome parameters.ResultsOf 512 patients included in our final analysis, 334 patients were primarily admitted to a surgical emergency service (SAG) whereas 178 were initially treated in a medical service (MAG). The latency between admission and cholecystectomy was significantly prolonged in the MAG with a median time to surgery of 2 days (Q25 1, Q75 3.25, IQR 2.25) compared to the SAG with a median time to surgery of 1 day (Q25 1, Q75 2, IQR 1) (p < 0.001). The duration of surgery was comparable between both groups. Necrotizing cholecystitis (27.2% vs. 38.8%, p = 0.007) and pericholecystic abscess or gallbladder perforation (7.5% vs. 14.6% p = 0.010) were less frequently described in the SAG. In the SAG, 85.7% of CCEs were performed laparoscopically, 6.0% were converted to open, and 10.4% were performed as open surgery upfront. In the MAG, 80.9% were completed laparoscopically, while 7.2% were converted and 11.2% were performed via primary laparotomy (p = 0.743). Histologically gangrenous cholecystitis was confirmed in 38.0% of the specimen in the SAG compared to 47.8% in the MAG (p = 0.033). While the prolonged preoperative stay led to prolonged overall length of stay, the postoperative length of stay was similar at a median of 3 days in both groups.ConclusionsTo our knowledge, we present the largest single center cohort of acute calculous cholecystitis evaluating the perioperative management and outcome of patients admitted to either medical or surgical service prior to undergoing cholecystectomy. In patients that were primarily admitted to medical emergency services, we found disproportionately more gallbladder necrosis, perforation, and gangrene. Despite prolonged time intervals between admission and cholecystectomy in the MAG and advanced cases of cholecystitis, we did not record a prolonged procedure duration, conversion to open surgery, or complication rate. However, patients with acute calculous cholecystitis should either be primarily admitted to a surgical emergency service or at least a surgeon should be consulted at the time of diagnosis in order to avoid disease progression and unnecessary health care costs.

ANÁLISE DA DISTRIBUIÇÃO ESPACIAL DAS URGÊNCIAS ODONTOLÓGICAS E SUA RELAÇÃO COM O SISTEMA ÚNICO DE SAÚDE

The study aims to analyze the profile of emergency service patients in dentistry (SUO-FOB) and the spatial analysis of their households concerning the network of Primary Health Care and emergencyin dentistryof the Brazilian Health System (SUS), in aprospective cohortstudy. The data were collected from February2017 to August2018 in theSUO-FOBand e-SUS, municipality of Bauru, São Paulo, Brazil. Among4,121 patients, 78.60% were between 20 and 64 years old, 81% presented pain as themain complaint, and the location of their households showed a spatial pattern of higher intensity of concentration in the outskirts of the city. This study evidencedthat the SUO-FOB contributes to oralhealth care in the municipality, especially in areas where it requiresimprovement. The university emergency services can help support the Brazilian health care network when demanded.

Professional Quality of Life of Nurses Providing Care for Patients with COVID-19

Objective: This study was conducted to determine the professional quality of life and care experiences of nurses who provide care for patients with COVID-19.Materials and Methods: The sample of this descriptive and cross-sectional study consisted of 181 nurses working in İstanbul (Turkey) which takes the first place according to the spread of the epidemic.Results: The nurses working for 1-4 years, 3 or more shifts per week, working in COVID-19 services, and providing care for 100 or more patients had higher compassion satisfaction scores.The compassion fatigue scores of those who were university graduates and worked 60 hours or more per week were found to be high. Those without children, high school graduates, those working 60 hours or more per week, those having 3 or more shifts per week, and those providing care for 100 or more patients in emergency services had higher mean scores on the professional quality of life.Conclusion: During the COVID-19 pandemic process, it is predicted that the level of compassion fatigue and burnout of nurses alarms. It is thought that reducing the workload and improving working conditions of nurse managers and leaders, the rotation of nurses between clinics, using methods of overcoming the stress.

Multidimensional characteristics of complex chronic patients in emergency services in primary care

<h2>ABSTRACT</h2><h3>Background</h3> In Spain, people between 65 and 74 years old have an average of 2.8 chronic problems or diseases, rising to 3.2 among people aged 75 and older. <h3>Aims</h3> We aimed to describe the multidimensional characteristics of complex chronic patients who sought urgent care. <h3>Design</h3> We conducted a descriptive, cross-sectional, retrospective study, drawing on a large electronic health record database in primary care in Barcelona, Spain. <h3>Methods</h3> We used health record data about subjects' clinical state, functional state, mental health state, social state, nutritional state, and movement. A descriptive analysis was carried out to determine percentages and means, given a standard deviation. <h3>Finding</h3> In 2019, 3,732 complex chronic patients sought urgent care at the centres under study. Subjects had a mean age of 82.5 ± 9.8 years, and 58.7% (n = 2,189) were women. Frailty was present in 69.3% (n = 2,586), and 81.7% (n = 3,050) were adherent to therapy. There were 2,470 visits to hospital emergency rooms (66.2%) and 1,651 hospital admissions (44.2%). Malnutrition was evident in 46.5% (n = 1,623) and 27.9% (n = 1,042) had low risk of social exclusion. <h3>Discussion</h3> Having such descriptive information can help health services from all areas and levels of care to use comprehensive, collaborative practices to care for complex chronic patients and their non-institutional caregivers. <h3>Conclusion</h3> We noted a high proportion of emergency room visits and hospital admissions among complex chronic patients. Low-level depression and malnutrition were detected. Proactive multidisciplinary interventions could improve the situation of these patients.

A STUDY ON FORECASTING THE IMPACT OF COVID-19 ON EMERGENCY SERVICE IN A PUBLIC HOSPITAL

The COVID-19 pandemic has seriously threatened human life all over the world since the first quarter of 2020. Hospitals have fought on the frontlines against this threat. The aim of this study is to predict the number of monthly emergency service patients for a public hospital. In particular, the impact of the COVID-19 pandemic on the number of emergency service patients was examined. While the data set for the period January 2012- June 2021 (114 months) is used in the analyses, two different data sets were created for the Box- Jenkins (B-J) and Gray Prediction approaches. Then, the number of monthly emergency service patients was predicted using the SARIMA model, GM (1,1) and TGM. In the analyses, while examining the long-term trend of the number emergency services patients’ using the SARIMA model, GM (1,1) and TGM were used to focus on the COVID-19 period. The findings suggest that the TGM has the most successful results in terms of evaluation criteria.

Evaluation of Waste Related to the Admission Process of Low-Complexity Patients in Emergency Services, in Light of the Lean Healthcare Philosophy

The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study aimed to map and analyze the value stream of patients classified as blue, green, or yellow in a Referral Emergency Unit. The evaluation research with analysis of processes was carried out in a teaching hospital on 30 patients seen at the emergency service. Value Stream Maps were drawn and the times involved in the process were calculated. Wastes and their possible causes were identified. A total of 13 maps were created and the mean process time between the activities involved in the process ranged between 7.3′ and 114.0′; the interruption time, between 0′ and 27.6′; the waiting time, between 43.2′ and 507.5′; and the lead time between 56.6′ and 638.0′ min. Some causes of waste were: high demand from patients; a shortage of personnel and offices. Following the Ishikawa Diagram, most of the waste is found regarding methods, human resources, and physical structure.

Accuracy of prehospital clinicians' perceived prognostication of long-term survival in critically ill patients: a nationwide retrospective cohort study on helicopter emergency service patients.

ObjectivesPrehospital critical care physicians regularly attend to patients with poor prognosis and may limit the advanced therapies. The aim of this study was to evaluate the accuracy of poor prognosis given by prehospital critical care clinicians.DesignCohort study.SettingWe performed a retrospective cohort study using the national helicopter emergency medical services (HEMS) quality database.ParticipantsPatients classified by the HEMS clinician to have survived until hospital admission solely because of prehospital interventions but evaluated as having no long-term survival by prehospital clinician, were included.Primary and secondary outcomeThe survival of the study patients was examined at 30 days, 1 year and 3 years.ResultsOf 36 715 patients encountered by the HEMS during the study period, 2053 patients were classified as having no long-term survival and included. At 30 days, 713 (35%, 95% CI 33% to 37%) were still alive and 69 were lost to follow-up. Furthermore, at 1 year 524 (26%) and at 3 years 267 (13%) of the patients were still alive. The deceased patients received more often prehospital rapid sequence intubation and vasoactives, compared with patients alive at 30 days. Patients deceased at 30 days were older and had lower initial Glasgow Coma Scores. Otherwise, no clinically relevant difference was found in the prehospital vital parameters between the survivors and non-survivors.ConclusionsThe prognostication of long-term survival for critically ill patients by a prehospital critical care clinician seems to fulfil only moderately. A prognosis based on clinical judgement must be handled with a great degree of caution and decision on limitation of advanced care should be made cautiously.

Abstract 9960: Soluble Low Density Lipoprotein Receptor-related Protein-1 Levels As A Potential Biomarker In Covid19

Introduction: Low density lipoprotein receptor-related protein 1 (LRP1), is a multifunctional receptor. Soluble form (sLRP1) is measurable as a novel biomarker of inflammation and atherosclerosis. We hypothesize that sLRP1 levels can be associated with Covid19 disease onset and severity. Methods: We measured sLRP1 levels in 180 PCR positive, Covid19 patients admitted to the hospital (mean age 60± 19, M/F = 51/49). Controls (n=61) were selected from outpatients without significant comobidities. Results: Covid19 patients display significantly lower sLRP1 levels compared to the controls (p&lt;0.001). Covid19 patients are stratified based on the severity of Covid19 such as emergency room (n=44), inpatient service (n=95) and intensive care (n=41). Median sLRP1 levels are 2.27, 1.26, 1.36, and 1.73 μg/ml for controls, emergency room, inpatient service and intensive care patients, respectively. sLRP1 levels rise as severity of Covid19 increases (p= 0.022) (Figure 1). Other biomarkers of inflammation such as CRP display similar trends (Figure 2). Median hsCRP levels are 8.2, 10.2 and 16.4 mg/L for emergency room, service and intensive care patients respectively (p&lt;0.001). Conclusions: Previous studies indicate that LRP1 can be a defense mechanism in acute viral infections. Eliminating LRP1 by siRNA knockdown increases intracellular cholesterol and the infectious virus yield. LRP1 displays a bidirectional course in Covid19. Low sLRP1 can be a risk factor for Covid19. On the other hand, sLRP1 levels increase with disease severity as a defense response to infection. This work was supported by the Research Fund of Istanbul Medeniyet University (project number 1358).

Suicide and Self-Harm Outcomes Among Psychiatric Emergency Service Patients Diagnosed As Malingering.

Malingering is a common and challenging clinical presentation in emergency departments (EDs). This study describes characteristics and outcomes among patients diagnosed as malingering in a psychiatric emergency service. Index psychiatric ED encounters were identified for all adult patients seen during a 27-month period. Mortality data were obtained for patients from the state public health authority, and repeat ED visits for self-harm were obtained from the state hospital association. Patients with a diagnosis of malingering were compared with those without a malingering diagnosis using correlative statistics and multivariable analyses. Of 4710 encounters analyzed, 236 (5%) had a malingering diagnosis. No patients diagnosed as malingering died of suicide within 365 days of discharge, compared with 16 (0.4%) nonmalingering patients. Self-harm outcomes were available for 2689 encounters; 129 (5%) had a malingering diagnosis. Malingering was significantly associated with a repeat ED visit for self-harm within 365 days in multivariable analyses (adjusted odds ratio 2.52; 95% confidence interval 1.35-4.70); p < 0.01). No psychiatric emergency service patients diagnosed as malingering died by suicide after discharge. New clinical approaches must balance malingering patients' apparent low suicide risk with their other substantial comorbidities and risk for self-harm.

Acil servise dispeptik yakınmalarla müracaat eden hastaların yönetiminin değerlendirilmesi

Aim: Dyspepsia means difficulty in the digestive process and consists of symptoms of bloating, pain, burning, early satiety, nausea and burping. Dyspepsia is one of the leading causes for applying to emergency services. Medical workups are overdone since there is still no consensus about the management of dyspeptic patients in emergency service. The aim of this article is to evaluate what is done for the management of patients with dyspeptic complaints in the emergency service.&#x0D; Materials and Methods:This study was conducted by retrospective file scanning method and consisted 2798 cases who applied to the emergency service between 1 January – 31 December 2019 with dyspeptic complaints. &#x0D; Results: Most of the patients who were included in the study were female (%58,1) and the average age was 39.73∓17,34. %77,8 (n=2176) of the included patients were treated by admission to the yellow area while %54,8 (n= 1534) was diagnosed with K29 (gastritis) according to the diagnostic codes. While 98.5% of the patients were discharged with outpatient treatment in the emergency observation room, only 1.5% were hospitalized. One case admitted with dyspepsia diagnostic code and presented with epigastric pain died.&#x0D; Conclusion: In this study, it was determined that patients with dyspeptic complaints present to the emergency department at a significant rate, but patients benefit from outpatient treatment at a rate of %98,5. A careful history taken from and detailed physical examination of patients with dyspeptic complaints for preventing unnecessary examinations and cost-effective behavior in the treatment are considered to be important for the preservation of national wealth.

Wrist fracture management and the role of surgical care practitioner through the patient's journey.

The presentation of this case study involves an exploration of the patient's journey in detail after having a traumatic wrist fracture, which is recognised as one of the most common fractures encountered daily in emergency services by junior doctors and practitioners. However, this article not only analyses the medical guidance for this type of case, but also the importance of the surgical care practitioner role in trauma and orthopaedics. All practitioners attending patients in emergency services are required to develop a good knowledge of anatomy, physiology, patient's examination technique, classifications and consequently being aware of the possible surgical options for treatment of the fracture. They will also need to fully understand the legal implications of consent to ensure safe practice.

Evaluation of an Integrated Psychology Service in a Pediatric Emergency Department and Urgent Care.

Children visiting emergency departments (EDs) are disproportionately affected by mental health disorders. Integrated behavioral health models hold promise for improving care among ED patients. We implemented and evaluated a novel behavioral health service integrated psychology trainees in a safety net hospital's pediatric ED and urgent care. Consultations and interventions provided were identified from the service's patient registry. Patients treated by the service were matched based on age, sex, day, and month of presentation to control patients who received a brief assessment by a specialized psychiatric nurse or patients receiving comprehensive management in a psychiatric emergency service. Rates of ED return visits were obtained from local hospital records, and insurance claims were used to identify rates of psychiatric hospitalization and outpatient follow-up care. The most commonly provided interventions among 71 intervention patients were assistance with connection to follow-up behavioral health treatment (65%), relaxation training (41%), and motivational interviewing (31%). These patients were matched with 142 comparison patients. There was no difference among groups in return rates within 90 days among intervention versus nurse assessment or psychiatric emergency service patients (25% vs 23% vs 13%, P = 0.14). Insurance claims data were available for 115 patients (54%): within 90 days, integrated care patients were less likely to have at least 1 outpatient claim (52% vs 78% vs 84%, P < 0.01), and there was no difference in rates of psychiatric hospital admission (18% vs 20% vs 24%, P = 0.83). Although this psychology-led integrated behavioral health service delivered a range of brief psychotherapeutic interventions, its impact on outpatient, inpatient, and emergency care was mixed. This lower follow-up rate among intervention patients may reflect the success of active psychological treatment in the ED, lower acuity among intervention patients, or implications of the study's safety net setting. The authors discuss this model's potential for enhancing mental health care in pediatric EDs.

Manchester Triage System: assessment in an emergency hospital service

to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System's priority level. a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol's high priority categories.

The Most Useful Method To Evaluate The Volume Status Of Critical Patients In The Emergency And Intensive Care Units: Point Of Care Ultrasound

Background: Accurate and rapid assessment of intravascular volume status of the patients in emergency services and intensive care units at diagnosis, treatment and follow-up stages is crucial yet rather difficult. The purpose of hemodynamic monitoring is to determine cardiovascular insufficiency and to provide the most suitable treatment for unstable patients in critical condition.&#x0D; Aim: The study aims to compare vena cava inferior diameter, vena cava inferior- collapsibility index (for spontaneously breathing patients) and vena cava inferior- distensibility index (for patients breathing on mechanical ventilation support) measurement by ultrasonography to central venous pressure measurement by placing invasive catheter for assessment of the intravascular volume status and making an accurate volume replacement in emergency service and intensive care units and to determine the correlation between them.&#x0D; Material and Methods: The study was carried out prospectively on the patients above the age of 18 who applied to the emergency service clinic between the dates of 01.06.2014 and 01.04.2015 or who stayed in the emergency intensive care unit between these dates. Measurements were taken from vena cava inferior in both the inspirium and expirium phases by using M mode and they were recorded in millimeter. Simultaneous central venous pressure measurements were performed on the patients by using manometric devices and the results were recorded in cm H2O.&#x0D; Results: 43.3% of the patients were female (n: 26) and 56.7% were male (n: 34), and the mean age is 70.58 ± 14.86. The study found high degree of positive correlation between central venous pressure and vena cava inferior diameters and high degree of negative correlation between vena cava inferior- collapsibility index . The study also found that there is a high degree of negative correlation between vena cava inferior- distensibility index and central venous pressure in patients receiving mechanical ventilatory support.&#x0D; Conclusion: Measurement of respiratory variation in vena cava inferior diameter by using ultrasonography is a quick, reliable, easily applicable, cost-efficient and non-invasive method in critical patients receiving mechanical ventilatory support or have spontaneous respiration in emergency services and intensive care units and it can be useful in assessing the volume status and estimating central venous pressure.

Autonomy of patients in emergency services in the border area: A phenomenology study

Abstract The absence of hospitals is one of the problems that arise in health services in remote areas. To get further medical care, patients must be referred outside the island. The purpose of this study was to reveal the situation and experience of patients in emergency treatment in border and coastal areas in North Kalimantan. This study was designed with a qualitative method and a descriptive phenomenological approach was used. It involved 10 participants who lived on Sebatik island with the criteria of having experience with emergency cases and being referred out of the island. Data analysis was performed using a thematic analysis of Braun and Clarke (2006). Three themes emerged from this study: inappropriate emergency actions, patients’ choice of using the right to be referred, and assistance in challenging referrals. It was revealed that emergency management was not maximal due to the limitations of health workers and service facilities. Patients chose the right to be referred to as an effort to get better health services.

Lethal Means Assessment in Psychiatric Emergency Services: Frequency and Characteristics of Assessment

Objective Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population level, yet individual-level uptake is less well understood. Methods Using automated data extraction methods, we conducted an investigation of electronic health records from psychiatric emergency service (PES) patients from January 1, 2012 to December 31, 2017 at a busy urban medical center in the Pacific Northwest. At each PES mental health evaluation, every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record lethal means access and other suicide risk factors. Results We assessed 32,658 records belonging to 15,652 patients. Among all visits, 69.9% (n = 22,824) had some documentation of lethal means assessment. However, 54.1% (n = 17,674) of all visits lacked some or all potential documentation detail. Additionally, among 59.6% of visits in which a patient had documented access to lethal means, the specific means available were not indicated. Across the twenty risk and demographic factors we assessed, the prevalence of documentation did not vary by any given risk factor and only varied minimally by age and race. For example, when comparing visits which indicated family history of suicide to those which indicated no family history of suicide, the prevalence ratio was 0.99 (95% CI: 0.95, 1.03). Conclusion Despite the high-risk patient population, mental health focus of the facility, and the presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings indicate that additional focus on implementation is needed to improve documentation of lethal means assessment. Highlights Fifteen times larger than prior comparable studies Findings demonstrate persistent under-documentation patterns in new setting and region Standardized methods likely needed to improve documentation detail and frequency

The Investigation of a Tertiary Hospital Emergency Service in terms of Quality Standards

Objective: Emergency services (ES) are the units where people first apply when they encounter an emergency and provide uninterrupted service 24 hours a day. The quality of these services is as important as the correct diagnosis and treatment of the patients in emergency services. Quality standards for emergency services (QSES) are the scales used for emergency services to provide quality service. In this study, the compliance status of a tertiary hospital emergency service with QSES was investigated.Methods: Data of emergency service recorded by the quality unit of a tertiary hospital between 01 January 2018 and 31 December 2018 were retrospectively analyzed.Results: It was found that a total of 90719 patients (27383 in 1st period, 28634 in the 2nd period, 7930 in the 3rd period, 28572 in the 4th period of 2018) applied to the emergency service in 2018. The patients were kept in the observation room for less than 6 hours, which is the target time for staying of patient. Less than 30 minutes when is the target time of the physician to reach the consultation could not be achieved. Less than 3% which is the target ratio of the patients re-applying to the emergency service within twenty-four hours with the same complaint was achieved. Less than 1% which is the target ratio of the patients sent from the emergency service to another center was achieved. Chi-square test test showed that there was a statistically significant difference between the periods in terms of all indicators (p&amp;lt;0.001). Conclusion: The hospital's situation regarding QSES was examined and quality targets were mostly met. However, additional measures are required to further improve the quality of the service provided in the emergency service.

Training plus intensive consultation improves uptake and outcome expectations of prolonged exposure therapy among practitioners treating emergency service personnel with post-traumatic stress disorder

Prolonged exposure (PE) therapy is an evidence-based psychological treatment of post-traumatic stress disorder (PTSD), yet uptake amongst practitioners is less than desirable. The aim of this study was to evaluate the efficacy of a PE training workshop plus intensive consultation programme to improve practitioners' self-efficacy and outcome expectations as well as uptake of PE for emergency service patients with PTSD. Forty-five psychologists attended a PE training workshop in Sydney. Participants completed questionnaires at pre- and post-workshop and six-month follow-up. The findings suggest that participation in the programme was associated with improvements in practitioners' beliefs in their ability to deliver PE to patients, an increase in their use of a range of PE components and an increase in their use of in vivo exposure with a greater proportion of patients. Effective training approaches for evidence-based treatments of PTSD should incorporate intensive consultation following training. Future studies should consider additional strategies to encourage practitioners to deliver PE to more patients with PTSD.