Medical Manpower Research Articles

Lessons from a COVID-19 hospital, Republic of Korea

ObjectiveTo document the experiences of converting a general hospital to a coronavirus disease 2019 (COVID-19) designated hospital during an outbreak in Daegu, Republic of Korea.MethodsThe hospital management formed an emergency task force team, whose role was to organize the COVID-19 hospital. The task force used different collaborative channels to redistribute resources and expertise to the hospital. Leading doctors from the departments of infectious diseases, critical care and pulmonology developed standardized guidelines for treatment coherence. Nurses from the infection control team provided regular training on donning and doffing of personal protective equipment and basic safety measures.FindingsKeimyung University Daegu Dongsan hospital became a red zone hospital for COVID-19 patients on 21 February 2020. As of 29 June 2020, 1048 COVID-19 patients had been admitted to the hospital, of which 22 patients died and five patients were still being treated in the recovery ward. A total of 906 health-care personnel worked in the designated hospital, of whom 402 were regular hospital staff and 504 were dispatched health-care workers. Of these health-care workers, only one dispatched nurse acquired COVID-19. On June 15, the hospital management and Daegu city government decided to reconvert the main building to a general hospital for non-COVID-19 patients, while keeping the additional negative pressure rooms available, in case of resurgence of the disease.ConclusionCentralized coordination in frontline hospital operation, staff management, and patient treatment and placement allowed for successful pooling and utilization of medical resources and manpower during the COVID-19 outbreak.

Iranian\u2019s healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake

BackgroundIn order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province.MethodsThe present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text.ResultsAnalysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges.ConclusionAccording to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran’s healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Ophthalmology as a Career Choice of Rotatory Medical Interns at Two Tertiary Hospital in Nigeria Middle Belt

The distribution of medical manpower among the various specialties should be of interest to government, health care planners and medical education of any nation. With this in mind, this study was design to determine the factors that may influence this specialty choice amongst interns especially in Nigerian middle belt. Ophthalmology is a unique field of medicine that combines the hypothesis generating intellectual aspect of diagnosis with the opportunity to perform procedures both in clinic and in the operating theatre. A cross-sectional study was conducted at Benue State University Teaching Hospital, Makurdi and Federal Medical Centre, Makurdi with a semi structured questionnaire. A total of 61 questionnaires were given out with 52 completely answered and returned given a response rate of 85.2% over a two week period. The mean age of the rotatory medical interns was 30.08 years with the youngest, 23 years and oldest, 42 years and a range of 19. Forty four (44) (84.6%) were male and eight (8) (15.4%) were female. The respondents mean age was 30.08 years with a range of 19. This is a dynamic work force and if effectively utilized will go a long way in the efforts at providing quality health care to the populace. The study also shows a significant relationship between the medical school attended and the choice of specialty. Concluding, factors influencing interns’ specialty choice should guide government’s health administrators and educators as they may be responsible for mal-distribution of medical manpower across the various specialties.

Nursing Perspectives on the Impacts of COVID-19

Nursing Perspectives on the Impacts of COVID-19

Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department

Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China....

Telemedicine in the era of COVID-19: The East and the West

Introduction: Telemedicine implies the application of clinical medicine by telephone, internet, or any other such networks for the purpose of consulting or performing various examinations or medical procedures. The present pandemic of COVID-19 is the ideal time to evolve telemedicine and increase its utilization for the well-being of humankind. Historical Background: Electrocardiogram transmission over telephone lines is the oldest record of telemedicine in the first half of the 20th century. Teleradiology commenced in India in 1996. The National Telemedicine Taskforce was set up by the Government of India, in 2005. The Arizona State Legislature established the Arizona Telemedicine Program in 1996. Medical devices to capture images were developed in the 1990s. Present Scenario in the East: Besides implementing various national-level projects, India has extended telemedicine services to South Asian and African countries. The Apollo Telemedicine Networking Foundation has grown to 115 centers, including 9 overseas. Recently, the Government of India has launched telemedicine solutions in the form of Social Endeavour for Health and Telemedicine and eSanjeevani. Comprehensive guidelines on telemedicine have also been issued during the COVID-19 pandemic. The Indian Navy is in the process of establishing teleconsultation centers on board several ships, submarines, remote locations, islands, and naval hospitals. Present Scenario in the West: Telestroke is the largest care provider for patients with stroke in the country. The field of dermatology is particularly suited for telemedicine. Telemedicine at sea is an integral part of rescue procedures. One of the fundamental components of medical assistance at sea is the Telemedical Maritime Assistance Service. Socioethical and Legal Considerations: Legal and regulatory measures will be a challenge with the rapidly spreading telemedicine network. Conflicting laws of different nations are some of the other legal issues in telemedicine. There exists an urgent need for specific legislation on telemedicine in India. In the USA, telemedicine covers various legal and regulatory issues at the state and federal levels. Limitations: Limited reimbursement or restrictions on reimbursement from insurance providers, quality of the patient–physician relationship, the quality of the examination, and the quality of care are a few barriers to telemedicine. The social limitation is probably the biggest limitation of telehealth. Conclusion: Despite several barriers, telehealth has shown remarkable growth during the COVID-19 pandemic. India with its large medical and IT manpower and expertise is emerging as a global leader in the field of telemedicine. The COVID-19 pandemic has made telemedicine more relevant than ever.

Nursing manpower allocation in Interventional Operating Room of a ClassIII Grade A hospital in Beijing

Objective To calculate the manpower of nurses in the clinical positions in Operating Room in a Class Ⅲ Grade A hospital, and to provide reference for appropriate allocation of human resources of nurses in Operating Room. Methods From January to December 2017, Hospital Nurse Management Regulations and Interventional Operating Room Nurse Job Description in Class Ⅲ Grade A hospital in Beijing were interpreted, and combined with on-site investigation and expert meeting, the list of nursing work items and the working hours record table for nurses in clinical positions in Operating Room were designed; the observation method and the hospital information system extraction method were used to measure the total working hours of the Operating Room nursing project, and the number of nurses required in the Operating Room was calculated. Results Totally 9 nurses for clinical positions were required for the Operating Room, including 8 angiographic nurses and 1 assistant nurse. Conclusions A total of 9 clinical nurses were needed in 4 operating units of the Operating Room. The ratio of operating units number to nurses number was close to 1: 2.5. Key words: Medical manpower; Interventional Operating Room; Human resource allocation; Hospital information system

THE ROLE OF PERSONNEL MONITORING IN THE EVALUATION OF INNOVATIVE MEASURES RELATED TO RESOURCES SUPPORT OF REGIONAL HEALTH CARE

The article presents calculation and analysis of medical manpower support of population as exemplified by such megalopolis as Moscow during implementation of the program of development of manpower of medical organizations and according to strategy of development of health care of the region. The time span of observation made up to 2013-2015 because up to that time the structural transformations in municipal health care system were factually finalized and conditions for analysis of achieved results took shape. It is established that higher support with physicians in the beginning of transformations, untypical on other territories, during three years moderately decreased and stabilized. The directions of optimization of number of physicians depending on types of medical organizations were reflected in predominant decreasing of number of established posts, in lesser degree - employed posts and in most lesser degree - number of individuals as workers. In polyclinics the process of division of labor between physicians and paramedical personnel increased. The conditions for amelioration of effectiveness of using physicians' resources and modes of remuneration of labor were organized. The presence of particular disproportions in physicians' manpower dictates necessity of proceeding monitoring of support of application of assessment and consideration of its results with the purpose of more rational distribution and priority directions of functioning of manpower resources.

Could we employ the queueing theory to improve efficiency during future mass causality incidents?

BackgroundPreparation for a disaster or accident-related mass casualty events is often based on experience. The objective measures or tools for evaluating decision-making and effectiveness during such events are underdeveloped. Queueing theory has been suggested to evaluate the effectiveness of mass causality incidents (MCI) plans.ObjectiveUsing different types of real MCI, we aimed to determine if a queueing network model could be used as a tool to assist in preparing plans to address mass causality incidents.MethodsWe collected information from two types of mass casualty events: a motor vehicle accident and a dust explosion. Patient characteristics, time intervals of every working station, numbers of physicians and nurses attending, and time required by physicians and nurses during these two MCIs were collected and used for calculation in a queueing network model. Balanced efficiency was determined by calculating the numbers of server, i.e., nurses and physicians, in the two MCIs.ResultsEfficient patient flows were found in both MCIs. However, excessive medical manpower supply was revealed when the queueing network model was applied to assess the MCIs. The best fitting result, i.e., the most efficient man power utilization, can be calculated by the queueing network models. Furthermore, balanced efficiency may be a more suitable condition than the highest efficiency man power utilization when faced with MCIs.ConclusionThe queueing network model is a flexible tool that could be used in different types of MCIs to observe the degree of efficiency when handling MCIs.

Inhibitory factors and problems associated with uniform access to cancer care: Perceptions of certified nurse specialists in cancer nursing

To elucidate the factors that obstruct uniform accessibility to care when oncology clinical nurse specialists (OCNSs) engage in medical care and to devise solutions for these obstructions. OCNSs enhance the quality of medical care, conduct activities as multidisciplinary coordinators, and provide public policy-related advice to maintain and improve the general population’s health. Therefore, OCNSs’ opinion is highly regarded, particularly in clinical setting. This study extracted and investigated the perceptions of OCNSs regarding factors inhibiting uniform access to care on the basis of a questionnaire with open-ended questions. Upon receiving the institutional review board’s approval, a questionnaire was distributed among 483 participants. Of these, 211 OCNSs affiliated with Core Oncology Centers who returned the filled questionnaire forms were enrolled. The recovery and effective response rates were 43.7% and 63.5%, respectively. Data were collected from the survey forms and subjected to qualitative and descriptive analyses. Inhibitory factors were categorized into the following five categories: (1) education and training systems; (2) medical specialties and workforce; (3) standard of medical care; (4) insufficient understanding on the part of administrators and the organization; and (5) policy. Each factor was further categorized into subcategories to elucidate the factors inhibiting universal access to care. Factors related to education and training systems affect factors related to medical specialties and manpower, leading to an imbalanced distribution of personnel between regions and facilities.

Paediatric Surgical Outreach to Papua New Guinea: Initial Experience

This is a report of our early experience in establishing a Paediatric surgical outreach program to Papua New Guinea (PNG) to build capacity and improve care. A Paediatric surgical outreach mission was initiated about 4 years ago in collaboration with Singhealth and PNG along with the multidisciplinary team of health care professionals from Cardiology, Cardiothoracic Surgery, Orthopaedics, Urology, Plastics and Anaesthesia. On each mission trip of 4 - 7 days duration, Singhealth doctors supervise or perform surgeries for complex cases, conduct patient consultations and give lectures to impart knowledge and transfer skills to the local health care community in PNG. In addition, a 6 - 12 months training program in Singapore for PNG doctors has been started. For complex cases which cannot be managed in PNG, there is provision for transfer of patients to Singapore under KKROK fund for further treatment. So far 4 mission trips have been conducted in past 4 years for paediatric surgical unit in Port Moresby General Hospital of PNG focussing on teaching and training of local Paediatric surgeons. Based on evaluation of the Singhealth medical team, there is severe shortage of medical manpower, surgical skill and specialised expertise. Due to lack of intensive care facility, adequate medications and proper medical equipment in the hospital, there are many conditions being left untreated causing high morbidity and mortality among infants and neonates. Such humanitarian work inspires Singhealth towards its global health mission of promoting health equity in responding to the medical needs of PNG through training and leveraging on strength through partnership. In addition, our doctors gain invaluable learning from the exposure, hone their skill as they treat a diversity of cases and are innovative in their treatment options by working in an environment with limited resources.

Stability and Change of Medical Specialty of Residents over Four Years of Postgraduate Training in Germany

Aim We analyzed medical residents' preferences in Germany with regard to the specialization fields after 4 years of postgraduate training and compared them to their preferences in the years before, e. g. at the end of undergraduate education in a gender comparative perspective, including the influence of parenthood. Methods The study is based on annual postal surveys of students of 7 medical faculties in Germany from their last year of medical school ("Practical Year") until after 4 years of postgraduate training. The return rate at baseline was 48% and in the 4 surveys thereafter the rates were 85% and above. In all samples, about two-thirds of respondents were women, which corresponds to the actual gender distribution in under- and postgraduate training. Descriptive statistics and regression analyses were used. Results Compared to the end of undergraduate education, anaesthesiology and general practice were the disciplines which gained in attraction, whereas surgical disciplines lost significantly in their attraction. These developments were similar in both genders. Specialized internal medicine, paediatrics and gynaecology lost attraction among female physicians only. We found important correlations of disciplinary preferences with parenthood and with the preference for part-time work after graduation. Conclusion The data show that "feminization" is not the reason why both anaesthesiology and general practice gained in attraction, since this happened over the 4 years among both male and female physicians. The loss in attraction in all great clinical disciplines, especially in surgery, orthopaedics and urology, may lead to severe problems in supply of medical manpower in the hospital, especially when combined with preference for part-time work.

Retention and Task Shifting in Human Resources for Health through Data Mining

Human resources for health (HRH) are the backbone of the healthcare system, but a shortage of medical manpower and the misdistribution of human resources are critical problems in the rural areas of many countries till 2017. The shortage of medical manpower is a big issue between 2004 and 2013. Data mining of bibliometrics is a good tool to find the solutions for shortage of medical manpower. By analyzing 118,092 citations in 2,000 articles published in the SSCI and SCI databases addressing HRH from 2004 to 2013, we plotted the networks among authors in the field. We combine quantitative bibliometrics and a qualitative literature review to determine the important articles and to realize the relationships between important topics in this field. We find that retention and task shifting are the hot topics in HRH field between 2004 and 2013, and find out the solutions for these issues through literature review in later papers. The solution to the HRH shortage is to determine the motivations of health workers and to provide incentives to maintain their retention. Task shifting is another solution to the HRH crisis.

The role of direct single monetary grants in residents’ choice of field of residency

Background: In an attempt to address severe medical manpower shortages in several medical disciplines, the Israeli Ministry of Health offered grants to residents who chose one of these fields.Methods: A total of 220 residents from various disciplines were surveyed on demographic, academic, and professional data, and asked to rank considerations in the choice of their field of residency.Results: Residents in targeted fields attributed significantly more importance to the grant in their decision-making process (U = 3704.5, p < 0.001). This effect remained significant in a multivariate model (OR 1.67, 95%CI 1.32–2.10, p < 0.001). Higher age (OR 1.15, 95%CI 1.01–1.31, p = 0.031) and attribution of significance to the working conditions compared to other residency fields (OR 1.69, 95%CI 1.23–2.32, p = 0.001) were significantly associated with receptivity toward the grant in a multivariate analysis.Discussion: Receptivity toward the offered grants correlated with real-life data shows a rise in physician in these fields, and the weak association between such receptivity and most variables tested may suggest that the grants were perceived as a property of the specific choice rather than a special bonus.Conclusions: Grants may be useful in diverting medical manpower. Further analysis and modeling are required to determine causal relationship and budgetary feasibility.

Assessment of diabetes care and the healthcare system in economically and transport underdeveloped rural mountain areas of western China: A cross-sectional survey.

The aim of the present study was to assess the quality of diabetes care and characteristics of the healthcare system in underdeveloped rural mountain areas of western China. Questionnaires were used to collect data from 288 diabetic patients with a multistage cluster sampling method in Zhongjiang County (Sichuan Province) between October 2009 and April 2010. Sixty-two village clinics, 23 town health centers, and a county central hospital were included to assess the availability of diabetes-related medical resources, in addition to diabetes-related medical insurance, reimbursement policies, and manpower. Of 288 patients, 38.2% monitored their blood glucose regularly. Targets for fasting blood glucose (≤7 mmol/L) and blood pressure (≤130/80 mmHg) were achieved by 7.6% and 9.7% of patients, respectively. On average, each patient paid US$120 out of pocket annually for out-patient diabetes care, with a maximum US$86 reimbursed. The county central hospital was the only healthcare facility in the county that could provide all essential diabetes-related drugs and process-of-care measures and tests, except measures of HbA1c and the urinary albumin: creatinine ratio. Insulin was not available at village clinics, and only 29% of village clinics had glucometers. "Certified" doctors were not available to provide primary care in village clinics. The quality of diabetes care was quite poor in underdeveloped rural mountain areas of western China. Recommendations for further intervention research to improve diabetes healthcare include increasing investment in medical infrastructure, improving the availability of essential drugs and process measures, organizing regular diabetes patient education, and recruiting village doctors.

A study to investigate the factors that influence the prescribing habits of non-consultant hospital doctors in Ireland.

The Health Service Executive estimates it spent just under €2 billion on medicines in 2013 following a fivefold increase in the cost of medicines over the preceding decade. With this increasing cost, it is important to understand what factors affect doctors prescribing. To investigate the influencing factors on prescribing of non-consultant hospital doctors (NCHDs) in Irish hospitals and to provide data regarding the sources of information NCHD's use for commonly prescribed drugs. All medical manpower offices of adult public hospitals in the Republic of Ireland were emailed with our survey for distribution to NCHDs. It contained demographic information and questions regarding factors which most influence their prescribing of particular drug groups. Tests of significance were carried out using Chi-square. One hundred and seventy-nine surveys were returned out of a possible 8987 (0.02%). Consultant preference was the biggest overall influencing factor on junior doctors prescribing (27%). This was closely followed by local departmental policies (26%). Evidence-based prescribing only influenced 14% of the total prescribing of NCHDs with the pharmaceutical representative influence only a fraction behind (13%). Knowledge obtained during medical school greater influenced postgraduate prescribing than undergraduate (34 vs 14%, p=0.046). Registrars were significantly more likely to prescribe using evidence-based medicine than intern and SHOs (p=0.03). The prescription of medications in Ireland by NCHDs varies greatly depending not only on drug group, but it is also affected by the doctors' previous education and experience. This information is key in leading to sensible cost-effective prescribing.

Healthcare sector efficiency in Gujarat (India): an exploratory study using data envelopment analysis

The importance of efficiency in resource utilization in healthcare sector has been recognized globally. In this paper we focus on efficiency of healthcare system at sub-state level (&lt;em&gt;i.e.&lt;/em&gt;, district level) in India using Gujarat state and its district level data for 2012-13. In spite of being an economically advanced state, in terms of infant mortality rate (IMR) the state is not the lowest. We explore the reasons for relative performance of different districts with data envelopment analysis (DEA). We used IMR as output variables. Using principal component analysis we tried a sub-set of variables, which had low correlations. Thus, four factor scores relating to medical officer, lady medical officer, Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy doctor, pharmacist, were used for DEA. We have focused on Charnes, Cooper, and Rhodes scores (or constant returns to scale technical efficiency score), and discussed efficiency rankings based on these. Thus, our results pertaining to district level health system efficiency in Gujarat State indicate that some of the districts have low efficiency in utilization of inputs like doctors, beds and workload per health institutions. There are also other districts, which need more of these inputs, which may enhance their output and efficiency. Thus, it is suggested that the efficiency in Valsad needs an improvement much more than other districts, whereas districts like Ahmadabad and Surat need more of both medical manpower and facilities. Even in case of Vadodara and Rajkot, the ranking in terms of most of medical manpower and facilities is low and thus these districts may also be benefitted by additional inputs. Hence, there is a mix of both inefficiency and inadequacy of inputs, which is reflected in our results.

Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk Population

To describe the short-term clinical outcomes of glenoid bone block augmentation in a high-demand population, as well as to describe its clinical success and complications at greater than 2years' follow-up in an at-risk military population. All patients undergoing anterior capsulorrhaphy with coracoid process transfer or anterior bone block augmentation (Current Procedural Terminology code 23662 or 23460) for shoulder instability between 2006 and 2012 were isolated from the Military Health System Management Analysis and Reporting Tool. Demographic and occupational parameters were identified, and multiple surgical factors and clinical outcomes were extracted from the medical record and US Defense Manpower Data Center. A total of 64 service members (65 shoulders) underwent anterior bone block procedures, including coracoid transfer (n= 59, 90.8%), distal tibial allograft (n= 3, 4.6%), and autologous or allograft iliac crest bone graft (n= 3, 4.6%). This group was predominately comprised of men (n= 59), and the mean age was 25.9years (range, 19 to 45years). A total of 19 perioperative complications, including 8 neurologic injuries, 6 infections, and 4 hardware failures, occurred in 16 patients (25%). At a mean 2.4-year follow-up, 21 patients (32.8%) reported persistent shoulder pain and 15 patients (23.4%) disclosed subjective apprehension or recurrent instability. Secondary surgical procedures were performed in 12 patients (18.8%), including 4 revisions (6.3%). Ultimately, 20 patients (31.3%) underwent a medical discharge for persistent shoulder disability. Univariate analysis showed that the presence of a perioperative complication (P= .049) and tobacco use (P= .038) were associated with increased risk of subsequent surgical failure. Anterior glenoid bone block procedures for shoulder instability with concomitant bone loss enable a return to high-demand physical function. The short-term complication profile (25%), recurrence rate (23%), and persistence of shoulder pain (33%) should be emphasized during preoperative counseling, particularly in an active military population and revision setting. Although moderately successful in the military, anterior bone block procedures for complex shoulder instability can beassociated with significant short-term complications and morbidity. Level IV, therapeutic caseseries.

Practise what you preach: health behaviours and stress among non-consultant hospital doctors

High rates of psychological distress, depression and suicide have been reported among doctors. Furthermore, many doctors do not access healthcare by conventional means. This study aimed to increase understanding regarding non-consultant hospital doctors’ (NCHDs’) response to stress and barriers to accessing supports, and identify possible solutions. Medical manpower departments in 58 hospitals distributed a 25-item questionnaire to 4,074 NCHDs; we received 707 responses (response rate, 17.4%). 60% of NCHDs were unable to take time off work when unwell; ‘letting teammates down’ (90.8%) and ‘difficulty covering call’ (85.9%) were the leading reasons. ‘Being too busy’ (85%), ‘self-prescription’ (66.6%) and ‘self-management’ (53.1%) were ranked highest in deterring NCHDs from visiting a general practitioner (GP). 22.9% of NCHDs would not attend a GP with anxiety or depression until they began to feel hopeless, helpless or suicidal. 12.2% would not seek help at all. 55% of respondents (n = 330) had to move away from partners or dependants due to work, negatively affecting the social supports of 82.9%. Possible practical solutions were explored. NCHDS are a vulnerable population and have a particularly challenging lifestyle. Key recommendations include improved GP and counselling access for NCHDs, and addressing the culture of self-treatment and poor health behaviours through undergraduate and postgraduate education.

Hypothesis: A single dose of an anxiolitic may prevent unnecessary visits to the emergency room during blood pressure elevations

Blood pressure (BP) monitoring devices are very commonly used by the general public for self-measurement. Approximately 19% of people using these devises check their BP every day or almost every day and only one third use them because their doctor recommended it. Measurement often causes anxiety and anxiety increases blood pressure in the short term. Elderly patients often visit the emergency room (ER) due to these BP elevations. Almost 10% of patients presenting to ERs complained of high BP, and between 50–75% of them receive antihypertensive drugs (sometimes with serious adverse effects) despite the fact that only 7.5% are classified as hypertensive emergencies, and only 2.8% are at risk of serious outcome.Two studies suggested the use of anxiolitics in the treatment of excessive hypertension. When compared to captopril, treatment with diazepam or alprazolam showed to be effective in lowering BP, with no significant difference between the two groups. We therefore suggest that patients with acute elevations of BP (measured at home) try an anxiolytic before deciding to go to the ER. Patients in which BP lowers with the use of tranquilizers do not need to go to the ER. We also suggest using this strategy in patients visiting community clinics and ER for the same reason.Our hypothesis is that by using our suggestions there will be a significant reduction in the number of unnecessary visits to the ER, the use of medication that may produce serious adverse effects, and an important health cost reduction, without increasing the risk for patients (a 10% reduction of ER visits may save up to 300 million dollars/year in the US alone and prevent unnecessary use of medical facilities and manpower).