Medical Staff In Emergency Department Research Articles

#924 Characteristics and outcomes of emergency department patients with acute kidney injury (AKI) stage 2 and 3 electronic alerts at a single UK centre

Abstract Background and Aims The epidemiology of Acute Kidney Injury (AKI) in hospitalized and critically ill populations has been well described but less is known about AKI in the emergency department (ED) patients. Community-acquired AKI represents about a quarter of AKI events observed in the hospital, and its incidence is increasing. Our aim was to look at the characteristics, early management, triage and outcomes of patients with AKI stage 2 and 3 alerts from busy emergency department. Method A retrospective review of patients with AKI 2 and 3 alerts from ED at Doncaster royal Infirmary (DRI) and Bassetlaw sister units in England over a 2 month period from August - September 2022 was conducted. All alerts from Ambulatory/SDEC (Same day emergency care) units have been excluded from this study. Data was gathered from trust electronic health system and patient discharge summaries. Results 158 AKI stage 2 and 3 alerts were received from ED at DRI and Bassetlaw of which 91 (57.5%) were AKI 2 alerts and 67 (42.4%) were AKI 3 alerts. Average age of patients was 73 yrs. Median length of stay in ED was 9hrs (Range 3 hrs–41 hrs). 44 (28%) patients died during this hospital episode of which 28 (64%) died in medical wards, 10 (23%) in critical care unit, 5 died in ED and 1 patient died in surgical ward. Average age of patients who died was 70 yrs and Median length of stay in ED was no different at 9hrs. 23 (52%) had sepsis as primary cause of death. 8 (18%) who died had active malignancy. 9 (20%) had either end stage heart failure/Liver failure or primary lung condition. 8 (18%) had either Frailty, Old age and/or Dementia listed as contributing to death. 8 (18%) patients were discharged home from ED. Discharge diagnosis was Dehydration and/or Falls. Only 4 of the 8 patients had AKI communicated to Primary care on ED discharge letter. 3 of the discharged patients had hospital readmission within 30 days. Looking at the initial intervention in ED, all patients had early warning score and initial resuscitation documented however none of the patients had Fluid balance charted. Bladder scan was performed on 15 (34%) patients where there was high suspicion of obstructive uropathy. Medication as a contributing factor to AKI was commented in 7 (4%) cases. Out of 106 patients who were discharged from hospital wards, sepsis, community acquired pneumonia, urinary tract infection and gastroenteritis were the commonest discharge diagnosis. Median length of Hospital stay was 11 days. Only 2 patients were admitted to specialist Renal ward directly from ED. AKI was communicated to primary care in 70 (62%) patients at discharge. 13 (12%) patients were readmitted to hospital within 30 days of discharge. Conclusion AKI is a marker of severity of illness and we note significant mortality in patients who present to ED with stage 2 and 3 AKI. Sepsis was commonest cause of death but we note a significant proportion of patients had either active malignancy or severe underlying chronic health condition. With increasing waiting times in ED, early recognition and AKI focused management is a priority. AKI education for nursing and medical staff in ED and Pharmacy input for patients who spend long hours in ED might help reduce length of overall hospital stay.

Digital stressors and resources perceived by emergency physicians and associations to their digital stress perception, mental health, job satisfaction and work engagement

BackgroundDigital technologies are increasingly being integrated into healthcare settings, including emergency departments, with the potential to improve efficiency and patient care. Although digitalisation promises many benefits, the use of digital technologies can also introduce new stressors and challenges among medical staff, which may result in the development of various negative work and health outcomes. Therefore, this study aims to identify existing digital stressors and resources among emergency physicians, examine associations with various work- and health-related parameters, and finally identify the potential need for preventive measures.MethodsIn this quantitative cross-sectional study, an online questionnaire was used to examine the relationship between digital stressors (technostress creators), digital resources (technostress inhibitors), technostress perception as well as mental health, job satisfaction and work engagement among 204 physicians working in German emergency medicine departments. Data collection lasted from December 2022 to April 2023. Validated scales were used for the questionnaire (e.g. “Technostress”-scale and the Copenhagen Psychosocial Questionnaire (COPSOQ). Descriptive and multiple regression analyses were run to test explorative assumptions.ResultsThe study found medium levels of technostress perception among the participating emergency physicians as well as low levels of persisting technostress inhibitors. The queried physicians on average reported medium levels of exhaustion symptoms, high levels of work engagement and job satisfaction. Significant associations between digital stressors and work- as well as health-related outcomes were analyzed.ConclusionThis study provides a preliminary assessment of the persistence of digital stressors, digital resources and technostress levels, and their potential impact on relevant health and work-related outcomes, among physicians working in German emergency departments. Understanding and mitigating these stressors is essential to promote the well-being of physicians and ensure optimal patient care. As digitisation processes will continue to increase, the need for preventive support measures in dealing with technology stressors is obvious and should be expanded accordingly in the clinics. By integrating such support into everyday hospital life, medical staff in emergency departments can better focus on patient care and mitigate potential stress factors associated with digital technologies.

Decision-making model for hospital selection in the emergency medical system

We designed a decision model for hospital selection in the emergency medical system, which integrates its actors, such as the dispatch center, emergency medical services (EMS), and emergency departments (ED). We designed and simulated the model using colored Petri nets to evaluate two policies: the nearest hospital policy (in time) and the proposed policy that integrates the proximity criteria and ED congestion. The simulation results for the Massachusetts Region 3 case study indicate that the proposed policy that considers the shortest transfer times (travel time + wait time) appropriately allocates ambulance patients to EDs. In addition, the proposed improves and balances indicators, such as average patient waiting times per ESI, physician utilization, and average patient queues, in each ED. For example, the proposed policy best scenario that adds a physician to all hospital EDs would reduce waiting times for ESI 2 and 3 patients between (26.16%–71.65%) and (74.69%–88.84%), respectively, and improve the patient queue and the allocation of ambulance patients. Finally, the proposed decision policy allows the planning of medical staff in EDs and scenario analysis using performance indicators focused on the timeliness of patient care. This approach would avoid problems such as overcrowding, delayed discharge, retention, and diversion of ambulances, putting patient health and life at risk.

Relationship between Feelings and Risk of Burnout Syndrome to the Medical Staff in the Emergency Department of Galati Hospital During the Covid 19 Pandemic Period

Introduction: Burnout syndrome is a manifestation of chronic stress caused by occupational stressors. The large number of patients infected with SARS Covid 2 has had a particular psychological impact on medical staff in Emergency Departments and only. Material and Methods: This was a descriptive study, of medical staff in the Emergency Department of the Galati County Emergency Hospital, which is in the front line in the fight against coronavirus. All 120 participants signed an informed consent form and then completed a socio-demographic questionnaire, self-designed questionnaire to identify feelings experienced at work during Covid- 19 Pandemic and the MBI - HSS (MP) (Maslach Burnout Inventory) to assess their burnout level. Results: The study found that 45% of the subjects were at high risk of Burnout. Medical staff in the Emergency Department show a degree of Burnout syndrome directly proportional to their experience in the field. Conclusions: The prevalence of Burnout syndrome in the Emergency Department is high, more than half of the physicians suffer from a high level of Burnout. Older age and less experience in the field and female gender are predictive factors for Burnout syndrome. Self-reported risk factors are increased overtime, workload, bureaucracy, lack of sleep, lack of respect from patients and colleagues, fear of exposure to the virus and patient care. Self-reported feelings of exhaustion, stress, and depression are dependent on symptoms of Burnout syndrome.

Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma.

PurposeTo evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia.MethodsA cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services.ResultsA total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up.ConclusionThere are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.

Protection measures against SARS-CoV-2 infection for cytopathology and histopathology laboratories personnel: practical recommendations.

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare workers are at high risk to be infected with this new coronavirus, particularly when they handle not only patients, but also their body fluids. In Romania, even though the protective measures to be used by medical staff in emergency departments, clinical departments, radiology departments, clinical laboratories and morgues services are well known, there is little information about the protection of medical staff in the laboratories of cytopathology and histopathology. In this article, we will discuss the transmission routes of the new coronavirus, the surfaces it could contaminate in a hospital, as well as the modalities of its inactivation. We will present some guidelines for preparing the pathology departments to face the pandemic situation like the present one. Also, we will point out some possible recommendations/suggestions for protective measures to be taken by laboratory staff during the cytological and histopathological procedures when they manipulate body fluids or surgical samples of patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Laboratory personnel should be aware that any body fluid or surgical specimen that arrives in the laboratory may contain SARS-CoV-2 and, as such, they should act after new working procedures. We recommend restraint from performing extemporaneous examination (smear and frozen section) and cytopathological examination in laboratories that do not have adequate condition for handling and processing Hazard Group 3 (HG3) pathogens, as SARS-CoV-2. Also, laboratory personnel should pay attention to instruments, technical equipment, or environmental surfaces as these also can be contaminated with the new coronavirus.

Establishment and Evaluation of a Time Series Model for Predicting the Seasonality of Acute Upper Gastrointestinal Bleeding.

ObjectiveWe aimed to establish and evaluate a time series model for predicting the seasonality of acute upper gastrointestinal bleeding (UGIB).MethodsPatients with acute UGIB who were admitted to the Emergency Department and Gastrointestinal Endoscopy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to December 2019 were enrolled in the present study. The incidence trend of UGIB was analyzed by seasonal decomposition method. Then, exponential smoothing model and autoregressive integrated moving average model (ARIMA) were used to establish the model and forecast, respectively.ResultsFinally, the exponential smoothing model with better fitting and prediction effect was selected. The smooth R2 was 0.586, and the Ljung-Box Q (18) statistic value was 22.272 (P = 0.135). The incidence of UGIB had an obvious seasonal trend, with a peak in annual January and a seasonal factor of 140%. After that, the volatility had gradually declined, with a trough in August and a seasonal factor of 67.8%. Since then, it had gradually increased.ConclusionThe prediction effect of exponential smoothing model is better, which can provide prevention and treatment strategies for UGIB, and provide objective guidance for more medical staff in Emergency Department and Gastrointestinal Endoscopy Center during the peak period of UGIB.

O005 / #486: INTUBATION PRACTICES FOR CHILDREN IN EMERGENCY DEPARTMENTS AND INTENSIVE CARE UNITS ACROSS AUSTRALIA AND NEW ZEALAND: A SURVEY OF MEDICAL STAFF

Aims & Objectives: Intubation of children in the emergency setting is a high risk, low incidence event. Standardisation of clinical practice has been hampered by a lack of high-quality evidence to support one technique over another. We aim to report clinician preference in intubation practice of children in emergency departments (EDs) and intensive care units (ICUs) in Australia and New Zealand as baseline information to allow targeted research focused on improving the safety of paediatric emergency airway management. Methods: A voluntary questionnaire was undertaken by medical staff in EDs and ICUs associated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) research networks. Respondents reported on their individual intubation practices. Results: A total of 502 clinicians were invited to complete the survey between May and October 2018 with 336 (66.9%) responding. There was marked variation in practice between ED clinicians and ICU clinicians in the in the techniques used for pre-oxygenation, the frequency of use of apnoeic oxygenation, and the reported use of video laryngoscopy.Conclusions: This survey highlights the self-reported variations in clinical practice in the intubation of children in the emergency and intensive care settings in Australia and New Zealand. While there is unlikely to be a one-size-fits-all approach to paediatric airway management, there is a paucity of high-quality evidence to support clinicians in adopting a best practice approach. Targeted research into preoxygenation techniques, the role and method of apnoeic oxygenation, and the role of VL in paediatric intubation is warranted.

Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China

BackgroundThe emergency department is considered to be a high-risk area, as it is often the first stop for febrile patients who are subsequently diagnosed with coronavirus disease 2019. This study, which employed a cross-sectional design, aimed to assess the mental health of emergency department medical staff during the epidemic in China. MethodsDemographic data and mental health measurements were collected by electronic questionnaires from February 28, 2020 to March 18, 2020. OutcomesA total of 14,825 doctors and nurses in 31 provinces of mainland China completed the survey. The prevalence rates of depressive symptoms and post-traumatic stress disorder (PTSD) were 25.2% and 9.1%, respectively. Men were more likely to have depressive symptoms and PTSD than women. Those who were middle aged, worked for fewer years, had longer daily work time, and had lower levels of social support were at a higher risk of developing depressive symptoms and PTSD. Working in the Hubei province was associated with a higher risk of depressive symptoms, while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms and PTSD. Being a nurse was associated with a higher risk of PTSD. InterpretationThe findings suggest that targeted psychological interventions to promote the mental health of medical staff with psychological problems need to be immediately implemented. Special attention should be paid to local medical staff in Hubei.

Mental Health Status of Medical Staff in Emergency Departments During the Coronavirus Disease 2019 Epidemic in China

Background: The emergency department is considered to be a high-risk area, as it is often the first stop for febrile patients who are subsequently diagnosed with Coronavirus disease 2019. This study aimed to assess the mental health of emergency department medical staff during the epidemic in China. Methods: This cross-sectional study was conducted from February 28, 2020 to March 18, 2020. Demographic data and mental health measurements were collected by electronic questionnaires. Outcomes: A total of 14,825 doctors and nurses in 31 provinces of mainland China completed the survey. The prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) were 25.2% and 9.1%. Men were more likely to have depressive symptoms and PTSD than women. Those with middle age, the fewer years working, longer daily work time and lower levels of social support had higher risk to have depressive symptoms and PTSD. Working in Hubei province was associated with a higher risk of depressive symptoms, while those working in Hubei province but who came from another province had a lower risk of depressive symptoms and PTSD. Being a nurse was associated with a higher risk of PTSD. Interpretation: Targeted psychological interventions to promote the mental health of medical staff with psychological problems needs to be immediately implemented. Special attention should be paid to local medical staff in Hubei. Funding Statement: This study was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-5-023), Hainan Provincial Science and Technology Major Project (ZDKJ201804) and Hainan Social Development Fund (ZDYFXGFY2020004). Declaration of Interests: The authors report no conflicts with any product mentioned or concept discussed in this article. Ethics Approval Statement: The study was approved by the institutional ethics board of the Second Affiliated Hospital of Hainan Medical University (No. 2020R011).

Relevant knowledge on heat stroke in emergency medical staff of China

Objective To investigate the knowledge about heat stroke among emergency medical staff in China, and to provide basis for further targeted training of emergency medical staff on heat stroke. Methods In August 2018, by purposive sampling, a total of 1 604 medical staff in emergency department were selected using the platform of the Chinese Nursing Association and the emergency committee platform of the Beijing Nursing Society including 22 provinces, autonomous regions and municipalities under the direct control of Central Government. A self-made questionnaire was used to investigate their knowledge of heat stroke. Results In the proportion of people who knew the core knowledge of heat stroke, the diagnostic key points accounted for 30.9%, the etiological classification accounted for 78.4%, the epidemiological characteristics accounted for 49.8%, and 13.3% for the treatment key points, and 78.6% for the prognosis. Among the ways to acquire knowledge of heat stroke, department training was the most common one (69.5%) . The factors influencing the perception of heat stroke among emergency medical staff were working length, occupation and professional titles (P<0.05) . Conclusions The findings indicate that emergency medical staff in Chinese hospitals still have insufficient knowledge of heat stroke. It is suggested to formulate targeted training plans, improve the quality of training through different methods, and better improve their professional level in order to improve the success rate of rescue and prognosis of heat stroke patients. Key words: Emergency service, hospital; Heat stroke; Medical staff

Emergency Medical Services and Quality of Care in Emergency Departments: Knowledge, Attitude and Practices among General Population in Rawalpindi, Pakistan

BACKGROUND Emergency medical services prove to be the backbone of a healthcare system for efficient management of emergencies. The quality of care is dependent on the training of healthcare professionals and proper infrastructure to deal with such emergencies.These services can only be effective if the general population has enough knowledge of the services and a positive attitude which may result in a change of their practices.This study aims to investigate the knowledge, attitude, and practices regarding Emergency Medical Services (EMS) and quality of care in Emergency Departments among general population in Rawalpindi, Pakistan. METHODS A cross sectional study was carried out at various public places in Rawalpindi using a self administered, validated 15-item questionnaire from 5th June 2018 to 31st July 2018. All participants above the age of 18 were included through convenience sampling. RESULTS Out of 191 people who completed the questionnaire, 66% were females (n=127) with the mean age of 30 years ±13. Most knew about the presence of an emergency helpline (70.15%), the specific number to call (74.35%), early transport of a serious patient to hospital (65%) and recognition of paramedics in an ambulance (61%). However, there was a general agreement on better transport through personal conveyance as compared to ambulances (40%), lack of trained paramedics in ambulances ( 39.7%), and provision of poor quality of care by medical staff in emergency departments (42%). CONCLUSION This study revealed that even though there is a good knowledge among members of the population, this knowledge has not significantly affected the attitude and practices of emergency medical services and care.

Prevalence and significance of coagulase-negative staphylococci isolated from blood cultures in a tertiary hospital

Blood cultures (BC) are the most important tool in the diagnosis of bloodstream infections. However, false positive results are associated with increased laboratory costs and inappropriate antibiotic use. In order to determine the prevalence and location of blood cultures contaminated with coagulase-negative staphylococci (CNS), we performed a retrospective analysis of all blood cultures performed at St. Vincent's Hospital, Sydney during a 6-month period. From a total of 4234 patients with BC collected, CNS was isolated from 109 patients (2.6%). 94% of all CNS isolates (101/109) were contaminants. In the emergency department (ED), CNS isolates were significantly more likely to be contaminants (62/63, p<0.02) compared with the rest of the hospital, representing a 3.3% patient BC contamination rate. Treatment for a contaminant with vancomycin was significantly more likely to occur in ward patients (14/28, p<0.01) compared to the rest of the hospital. Duration of therapy did not differ across the hospital. Strategies to reduce the numbers of contaminants should be directed at medical staff in ED. Inappropriate vancomycin therapy could be curtailed by greater clinical microbiology liaison and vancomycin stewardship.