Emergency Patients Research Articles

Emergency patient forecasting with models based on support vector machines

<p>Understanding the dynamic nature of the influx of patients is crucial for efficiently managing supplies, medical personnel, and infrastructure in an emergency room (ER). While overestimation can lead to resource wastage, underestimation can result in shortages and compromised service quality. This study addresses emergency patient forecast by means of implementing support vector machine (SVM) algorithms. Along four phases (analysis, design, development, and validation), more than 50,000 ER records were preprocessed and analyzed. Traditional error metrics such as mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and mean absolute percentage error (MAPE) were utilized alongside monthly consolidated forecasts. To benchmark performance, actual values and forecasts derived from linear regression (LR) models were used. Experiments revealed that LR models had lower errors compared to SVM models. However, monthly consolidated forecasts showed that SVM-based models underestimated less than LR-based models. In conclusion, SVM-based models could help planners to accurately estimate the requirements for supplies and medical personnel during the period under study.</p>

Patterns and characteristics of visits to psychiatric emergency departments: a three-year data study in China.

The composition and characteristics of emergency patients in the Affiliated Brain Hospital, Guangzhou Medical University during 2020-2022 were retrospectively analyzed to provide data support for the optimization of the process of psychiatric emergency and the elastic allocation of emergency medical staff. This study collected data from patients who sought medical attention at the emergency department of the Affiliated Brain Hospital, Guangzhou Medical University between January 1, 2020, and December 31, 2022. The fundamental information of these patients was statistically analyzed using descriptive analytic methods. In addition, a comprehensive statistical analysis was performed on the data of patient visits, which included precise triage time points, months, and seasons, in order to evaluate the temporal distribution of patient visits. The patient population had an average age of 36.4 years and was slightly more female (54.08%). The mean age of the male and female patients was 36.4 ± 18.91 and 36.4 ± 16.80 years, respectively. There was no statistically significant age difference between the male and female patients (p > 0.05). The top five diseases were mental disorder (6,483 cases), bipolar disorder (3,017 cases), depressive episode (2522 cases), schizophrenia (1778 cases) and anxiety state (1097 cases), accounting for 35.63%, 16.58%, 13.86%, 9.77% and 6.03% of the total, respectively. Additionally, a notable record of psychiatric drug intoxication was noted. Significant comorbidity with physical disorders, such as hypertension (9.36%), hypokalemia (3.41%), diabetes (2.83%), and cerebral infarction (2.79%), was also seen. The results of seasonal and monthly analysis indicated that emergency attendance patterns fluctuated, peaking in the spring and fall. The patterns of daily visits also revealed two peak times. The first peak occurs from 8:00 to 10:00, and the second peak occurs from 14:00 to 16:00. This study emphasizes the increasing occurrence of mental problems in psychiatric crises, particularly among younger populations, underscoring the necessity for comprehensive care methods. Specialized treatment methods and collaborative networks are required to address the substantial prevalence of psychiatric medication poisoning. Efficient allocation of resources and heightened security protocols are vital in emergency departments, particularly during periods of high demand and in handling instances of patient hostility.

Overview of Knowledge about Basic Life Support (BLS) for Nature Lovers Students

Basic life support (BLS), comprising cardiovascular resuscitation and automated external defibrillator use, is not exclusively taught to health care workers but also to layman. BLS could save the lives of trauma and/or other emergency patients, particularly where health care facility is unreachable. Students’ mountaineering club members particularly are under constant risks of these conditions. There has been no study regarding BLS knowledge profile in North Maluku, especially among students’ mountaineering club members. Objective: To describe the level of knowledge about BLS among students’ mountaineering club members at Khairun University. Methods: This observational, descriptive, cross-sectional descriptive study was conducted on all students’ mountaineering club members at Khairun University in 2022. Analysis was performed using univariate analysis. Results: Among 123 respondents from 14 study programs, most were male (57,7%), were civil engineering students (22,2%), and had previous BLS training (87,8%). Regarding the level of BLS knowledge, 6,5% had good knowledge, 50,4% mediocre, and 43,1%had low level of knowledge. Conclusion: Most students’ mountaineering club members at Khairun University had mediocre level of knowledge regarding BLS. Further study is required to confirm this finding.

Multisource data framework for prehospital emergency triage in real-time IoMT-based telemedicine systems

Background and objectiveThe Internet of Medical Things (IoMT) has revolutionized telemedicine by enabling the remote monitoring and management of patient care. Nevertheless, the process of regeneration presents the difficulty of effectively prioritizing the information of emergency patients in light of the extensive amount of data generated by several integrated health care devices. The main goal of this study is to be improving the procedure of prioritizing emergency patients by implementing the Real-time Triage Optimization Framework (RTOF), an innovative method that utilizes diverse data from the Internet of Medical Things (IoMT). MethodsThe study’s methodology utilized a variety of Internet of Medical Things (IoMT) data, such as sensor data and texts derived from electronic medical records. Tier 1 supplies sensor and textual data, and Tier 3 imports textual data from electronic medical records. We employed our methodologies to handle and examine data from a sample of 100,000 patients afflicted with hypertension and heart disease, employing artificial intelligence algorithms. We utilized five machine-learning algorithms to enhance the accuracy of triage. ResultsThe RTOF approach has remarkable efficacy in a simulated telemedicine environment, with a triage accuracy rate of 98%. The Random Forest algorithm exhibited superior performance compared to the other approaches under scrutiny. The performance characteristics attained were an accuracy rate of 98%, a precision rate of 99%, a sensitivity rate of 98%, and a specificity rate of 100%. The findings show a significant improvement compared to the present triage methods. ConclusionsThe efficiency of RTOF surpasses that of existing triage frameworks, showcasing its significant ability to enhance the quality and efficacy of telemedicine solutions. This work showcases substantial enhancements compared to existing triage approaches, while also providing a scalable approach to tackle hospital congestion and optimize resource allocation in real-time. The results of our study emphasize the capacity of RTOF to mitigate hospital overcrowding, expedite medical intervention, and enable the creation of adaptable telemedicine networks. This study highlights potential avenues for further investigation into the integration of the Internet of Medical Things (IoMT) with machine learning to develop cutting-edge medical technologies.

ANÁLISE COMPARATIVA ENTRE A EFICÁCIA DIAGNÓSTICA DA RADIOGRAFIA E ULTRASSONOGRAFIA EM PACIENTES COM PNEUMOTÓRAX

INTRODUCTION: Pneumothorax is a serious medical condition, caused by the presence of air in the pleural cavity, which can lead to serious complications and even be fatal if not treated quickly. Chest radiography is the traditional diagnostic method, but it has limitations, and in this context, ultrasound has stood out as a promising alternative for the diagnosis of pneumothorax, having high sensitivity and specificity in some contexts. OBJECTIVES: This article aims to compare the diagnostic accuracy of ultrasound and chest radiography in the emergency department. METHODOLOGY: We carried out a broad search in several academic databases, using several Health Sciences Descriptors. The objective was to retrospectively compare the diagnostic accuracy of pneumothorax between radiography and ultrasound performed by non-radiologists in emergency patients. RESULTS: This study analyzed the effectiveness of chest radiography and ultrasound in diagnosing pneumothorax. 10 studies were included, 9 of which used the patient as the unit of analysis, with 1170 patients, and 460 with confirmed traumatic pneumothorax. 80% of studies presented a high risk of bias in patient selection. There was heterogeneity in the sensitivity of chest radiography, indicating the influence of the size of the pneumothorax, clinical conditions, and imaging techniques. Ultrasonography showed greater sensitivity and specificity than radiography; however, the results highlight the importance of considering different clinical contexts when choosing the best imaging modality to diagnose pneumothorax in emergencies. CONCLUSION: Thoracic ultrasound performed by non-radiologists is more accurate in diagnosing pneumothorax in emergency room trauma patients than chest radiography. The results highlight the potential of ultrasound as an effective diagnostic tool, easily integrating into trauma care protocols. Its use in medical training programs can improve the speed and accuracy of diagnosing critical conditions such as pneumothorax. The routine use of ultrasound in trauma management can bring positive changes to clinical practice, offering faster and safer interventions to patients.

Spectrum of diseases and injuries presentation among patients visiting Emergency Department at Janaki Medical College Teaching Hospital

Background & Objectives: The Global Burden of Disease study is a systemic effort to quantify the comparative magnitude of the health loss due to diseases, injuries and risk factors by age, sex and geographies in specific point of time. Five out of ten causes of disease burden in 2017 in Nepal are Non-Communicable Disease (NCDs), ischemic heart disease (IHD), Chronic Obstructive Pulmonary Disease (COPD), Lower Respiratory Tract Infection (LRTI) and Tuberculosis (TB). We aimed to find out the demographic, clinical presentation and outcome of Emergency patients at Janaki Medical College Teaching Hospital (JMCTH) Emergency department. Materials and Methods: A descriptive observational study of patients visiting ED at Janaki Medical College, Ramdaiya, Bhawadi, Dhanusha. Distinctiveness of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from 2023-04-15 to 2023-07-18. Post-ED mortality, patient households were followed-up by telephone interviews at 90 days. Patients were diagnosed, treated and admitted in different wards for further evaluation and treatment. Data were collected, analyzed, interpreted, using SPSS version 20. Results: The majority of patients were male (55.58%) predominantly from Dhanusha (79.4%). Common symptoms included musculoskeletal pain (16.5%), abdominal pain (13.3%), and fever (9.9%). The most common diseases were acute pain abdomen (21.26%) and hypertension (11.06%), Abrasions (35%) and cut injuries (13.59%) were the most frequent injuries. Most of the patients were admitted to the observation ward (52.9%). Conclusion: Most patients attending emergency department were young males from Dhanusha, primarily of Terai Madheshi and other castes. The results emphasize the necessity of better emergency care services and public health initiatives in Janakpurdham, as well as the critical role of emergency departments which provides services in wide range of acute and chronic diseases.

Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study.

Pneumonia accounts for over half a million older adult emergency department (ED) visits annually, but ED pneumonia diagnosis is inaccurate. Geriatric-specific pneumonia diagnostic criteria exist for other settings; no prospective data exist to determine if application in the older adult ED population is feasible. The objective was to prospectively evaluate the utility of four current diagnostic criteria (Loeb; Modified McGeer; Infectious Disease Society of America/American Thoracic Society; American College of Emergency Physicians) in older adult ED patients. This was a prospective, observational cohort study of older adult ED patients ≥65 years of age in two U.S. EDs with suspected pneumonia defined as having chest radiography ordered and treating physician suspicion. The standard we used for defining the presence, absence, or inability to determine a diagnosis of pneumonia diagnosis was expert physician chart adjudication. We report the summary statistics for demographic characteristics and symptoms/exam findings and sensitivity, specificity, and likelihood ratios with 95% confidence intervals of the existing diagnostic criteria. Pre-specified cutoff values of a positive LR >10 and a negative LR <0.3 were considered clinically significant. Of 135 patients enrolled, 27 had pneumonia by adjudicator review. Typical patient-reported pneumonia symptoms, such as fever (18.5%) and new/worse cough (51.9%), were not consistently present in pneumonia. The IDSA/ATS and ACEP criteria had positive LR >10 and negative LR <0.3; however, all confidence intervals included pre-specified cutoffs. Older adults presented to the ED with low frequency of typical pneumonia symptoms. Although existing diagnostic definitions had promising test characteristics, they may not perform well enough for clinical application without refinement.

Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience.

Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.

The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital.

Background: The respiratory adjusted shock index (RASI) is a risk score whose usefulness in patients with sepsis and trauma has previously been reported. However, its relevance in elderly emergency patients with medical diseases is yet to be clarified. This study assessed the usefulness of the RASI, which can be evaluated without requiring special equipment, to provide objective and rapid emergency responses. Methods: In this retrospective study, we recruited patients with medical diseases, aged 65 years or older, who were transported to the emergency room from Tokushima Prefectural Kaifu Hospital and underwent arterial blood gas testing from 1 January 2022 to 31 December 2023. We investigated the association of the RASI with other indices, including the lactate level, National Early Warning Score 2 (NEWS2), Shock Index (SI), Sequential Organ Failure Assessment (SOFA) score, quick SOFA (qSOFA) score, and systemic inflammatory response syndrome (SIRS). Results: In this study, we included 260 patients (mean age, 86 years), of whom 234 were admitted to the hospital; 27 and 49 patients died within 7 and 30 days of admission, respectively. The RASI was positively correlated with the lactate level, NEWS2, SI, and increase in the SOFA score (p < 0.001). The RASI was higher in patients with a SIRS or qSOFA score ≥ 2 than in those without (p < 0.001). It predicted death within 7 and 30 days of admission with an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.73-0.87), sensitivity of 96.3%, and specificity of 53.6% when the cutoff value was set to 1.58 and with an AUC of 0.73 (95% CI: 0.66-0.81), sensitivity of 69.4%, and specificity of 70.6% when the cutoff value was set to 1.83, respectively. Conclusions: The RASI is a simple indicator that can be used for predicting in-hospital outcomes in elderly emergency patients with medical diseases. Larger prospective studies based on this study are needed.

Delirium prevalence in emergency department patients: A systematic review and meta-analysis.

Delirium is a common acute mental disorder, and its adverse outcomes often cause distress to both patients and their families. Despite its prevalence in patients treated in emergency departments, delirium is frequently overlooked. This study aims to systematically evaluated and meta-analysis the prevalence of delirium among emergency patients, providing insights into its prevalence and offering guidance for its management and prevention. Observational studies on the prevalence of delirium in emergency departments were systematically searched in PubMed, Embase, the Cochrane Library and Medline databases. Relevant English-language studies published up to 18 September 2023 were reviewed, and meta-analysis was conducted using Stata 14.0 software. Quality assessment of included literature was performed using the methodological index for non-randomized studies (MINORS), and publication bias was assessed using Egger's test. Thirteen studies encompassing a total sample size of 33 839 cases were included, with 3082 cases of delirium incidents. The findings revealed a 15% prevalence rate of delirium in emergency departments, with a 95% confidence interval (CI) of (0.10, 0.20) and an overall heterogeneity of 98.37% (p = .000). Among emergency department patients over 65 years of age, the prevalence of delirium was 12%, with a 95% CI of (0.07, 0.19) and a heterogeneity of 94.59%. For patients over 18 years of age, the prevalence was 17%, with a 95% CI of (0.10, 0.25) and a heterogeneity of 98.94%. This meta-analysis reveals an overall 15% prevalence rate of delirium among patients in emergency departments. In clinical practice, emergency medical staff should strengthen the screening and management of emergency delirium patients.

Is more care recipient time at home also a family caregiver-centered quality of life measure?

Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)-to understand how care recipient days not at home correspond to family caregiver QoL. Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted "days not at home" variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden). In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%-3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (-0.1%). An IP day had a slight protective effect (-0.2 to -0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (-0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL. Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.

Rabies post-exposure prophylaxis in the emergency department: A monocentric retrospective observational study

BackgroundEmergency departments (ED) are frequently visited after suspected rabies exposure (SRE) and the potential need for rabies post-exposure prophylaxis (R-PEP). However, data on the number of visits, patients' demographics, travel history and the medical treatment is still rare. Therefore, the aim of this study was to assess the number of R-PEP and the appropriateness of medical management including wound treatment, vaccination regime and immunoglobulin application following SRE in a university hospital ED. MethodWe conducted a monocentric retrospective observational study on emergency patients treated in the ED of the LMU University Hospital, Ludwig-Maximilians-University Munich, Germany, between June 1st, 2023 and January 31st, 2024. Patients requiring post-exposure prophylaxis due to SRE abroad or in Germany were included. Demographic data, travel history, clinical findings, wound treatment, and R-PEP vaccination regimen were recorded. ResultsDuring the observation period of 245 days 43 patients presented to our ED for R-PEP. There was a total of 51 presentation appointments, as 5 patients returned for further treatment. Most patients (27, 52.9 %) presented at the ED on a Saturday, Sunday, or a public holiday. 17 (39.5 %) patients had a category II exposure, and 26 (60.5 %) had a category III exposure. In our ED, there were 28 (55.0 %) active vaccinations and 23 (45.0 %) both active and passive vaccinations. ConclusionsOur data show that patients frequently present for R-PEP in ED. Therefore, there is a high need for education on indication for R-PEP and for implementation of precise R-PEP treatment guidelines in daily clinical practice.

“Psychiatric emergency consultations of minors: a qualitative study of professionals’ experiences”

BackgroundPsychiatric emergency assessment of minors can be a complex process, especially for professional staff who are not specifically trained in handling child and adolescent emergency patients. As minors cannot usually express their feelings and experiences as well as adults, it is difficult to form an accurate picture of their condition and to determine what kind of emergency care is needed, for instance whether or not a psychiatric emergency admission is necessary. We lack insight in what professionals at emergency departments need to adequately assess these minors and their families. The aim of this study was to explore staff members’ experiences with assessing minors and explore recommendations for improving their ability to provide appropriate support.MethodsGuided by a topic list with open-ended questions, we conducted 11 semi-structured interviews with staff working at psychiatric emergency services. Thematic analysis enabled us to identify five main themes: (1) young age and the crucial role of parents; (2) professionals’ feelings, especially uncertainty; (3) psychiatric emergency admissions and the alternatives to them; (4) regional differences in organization and tasks; and (5) options for improving care.ResultsThe staff interviewed all agreed that it was often complicated and time consuming to take full responsibility when assessing minors with serious and urgent psychiatric problems. Most found it difficult to determine which behaviors were and were not age-appropriate, and how to handle systemic problems during the assessment. When assessing minors and their families in crisis, this led to uncertainty. Professionals were especially insecure when assessing children under age 12 and their families, feeling they lacked the appropriate knowledge and routine.ConclusionCustomized expertise development and improved regional embedding of the psychiatric emergency service in the child and adolescent services will reduce professionals’ uncertainty and improve psychiatric emergency care for minors.

Multicenter Analysis of Emergency Patient Severity through Local Model Evaluation Client Selection: Optimizing Client Selection Based on Local Model Evaluation

In multi-institutional emergency room settings, the early identification of high-risk patients is crucial for effective severity management. This necessitates the development of advanced models capable of accurately predicting patient severity based on initial conditions. However, collecting and analyzing large-scale data for high-performance predictive models is challenging due to privacy and data security concerns in integrating data from multiple emergency rooms. To address this, our work applies federated learning (FL) techniques, maintaining privacy without centralizing data. Medical data, which are often non-independent and identically distributed (non-IID), pose challenges for existing FL, where random client selection can impact overall FL performance. Therefore, we introduce a new client selection mechanism based on local model evaluation (LMECS), enhancing performance and practicality. This approach shows that the proposed FL model can achieve comparable performance to centralized models and maintain data privacy. The execution time was reduced by up to 27% compared to the existing FL algorithm. In addition, compared to the average performance of local models without FL, our LMECS improved the AUC by 2% and achieved up to 23% performance improvement compared to the existing FL algorithm. This work presents the potential for effective patient severity management in multi-institutional emergency rooms using FL without data movement, offering an innovative approach that satisfies both medical data privacy and efficient utilization.

Evaluation of Online Virtual Patient Simulation Training for Managing Acute Patients with an Emphasis on Meaningful Learning

Objective: To evaluate the meaningful learning aspect of emergency patient management training conducted using an on-line virtual patient simulator. Methods: Case-based trainings which is a part of curriculum were conducted on-line using a Virtual Patient Simulator (VP) under the guidance of an educator in the years 2019-2020.The course was designed according to FTL(Fascilitation,training,learning) Model. The data in this study consisted of the survey results completed by 2nd year Emergency and First Aid Department students of Acibadem University (n:38/54) before and after the training sessions. The survey used was Keskitalo’s survey .The data were analyzed by using descriptive statistics. The paired-samples t-test was used to compare the differences between the students’ expectations and their experiences. Results: The results obtained indicate that meaningful learning expectations, including concrete, metacognitive, individual and competency-based, characteristics were exceeded by the experiences (p

A pre-trained language model for emergency department intervention prediction using routine physiological data and clinical narratives

IntroductionThe urgency and complexity of emergency room (ER) settings require precise and swift decision-making processes for patient care. Ensuring the timely execution of critical examinations and interventions is vital for reducing diagnostic errors, but the literature highlights a need for innovative approaches to optimize diagnostic accuracy and patient outcomes. In response, our study endeavors to create predictive models for timely examinations and interventions by leveraging the patient’s symptoms and vital signs recorded during triage, and in so doing, augment traditional diagnostic methodologies. MethodsFocusing on four key areas—medication dispensing, vital interventions, laboratory testing, and emergency radiology exams, the study employed Natural Language Processing (NLP) and seven advanced machine learning techniques. The research was centered around the innovative use of BioClinicalBERT, a state-of-the-art NLP framework. ResultsBioClinicalBERT emerged as the superior model, outperforming others in predictive accuracy. The integration of physiological data with patient narrative symptoms demonstrated greater effectiveness compared to models based solely on textual data. The robustness of our approach was confirmed by an Area Under the Receiver Operating Characteristic curve (AUROC) score of 0.9. ConclusionThe findings of our study underscore the feasibility of establishing a decision support system for emergency patients, targeting timely interventions and examinations based on a nuanced analysis of symptoms. By using an advanced natural language processing technique, our approach shows promise for enhancing diagnostic accuracy. However, the current model is not yet fully mature for direct implementation into daily clinical practice. Recognizing the imperative nature of precision in the ER environment, future research endeavors must focus on refining and expanding predictive models to include detailed timely examinations and interventions. Although the progress achieved in this study represents an encouraging step towards a more innovative and technology-driven paradigm in emergency care, full clinical integration warrants further exploration and validation.

Surgery scheduling in flexible operating rooms by using a convex surrogate model of second-stage costs

We study the elective surgery planning problem in a hospital with operating rooms shared by elective and emergency patients. This problem is split in two distinct phases. First, a subset of patients to be operated in the next planning period is selected and the selected patients are assigned to a block and a tentative starting time. Then, in the online phase of the problem, a policy decides how to insert the emergency patients in the schedule and may cancel planned surgeries. The overall goal is to minimize the expectation of a cost function representing the assignment of patient to blocks, case cancellations, overtime, waiting time and idle time. We model the offline problem by a two-stage stochastic program, and show that the optimal second-stage costs can be approximated by a convex piecewise linear surrogate model that can be computed in a preprocessing step. This results in a mixed integer program which can be solved very fast, even for large instances of the problem. We also describe a greedy policy for the online phase of the problem, and analyze the performance of our approach by comparing it to both heuristic methods or approaches relying on sampling average approximation (SAA) on a large set of benchmarking instances. Our simulations indicate that our approach can reduce the expected costs by as much as 30% compared to heuristic methods and it can solve problems with 1000 patients in about one minute, while SAA-approaches fail to obtain good solutions within 30 min on small instances.

Exploring Gender Disparities in Emergency Department Utilization: A Comprehensive Comparative Analysis of the Frequency of Female Versus Male Emergency Department Visits.

Background The emergency department (ED) serves as the front line for emergency patient care, a unique limbo between the realms of generalist care and specialists and outpatient and inpatient care. As the trend of utilizing emergency healthcare services has escalated in the past 10 years, it becomes interesting to look at the patient characteristics of those who have utilized the ED. This analysis can guide the operation of impartial care for all ED patients to ensure equal access and discourage disparity based on the patient's sex. Methods This cross-sectional analysis seeks to examine differences in the frequency of patient visits to the ED in the United States (US) based on the patient's sex. The study utilizes data from the period 2012 to 2021, which was derived from the Nationwide Emergency Department Sample (NEDS). Results Analyzing both the rates of female and male visits to the ED on a year-by-year basis within the study period, it was observed that a higher proportion of females visit the ED, and, in general, both females and males have visited the ED less frequently in recent years. However, while the female sex has continued to represent the majority of ED patients, the gap between the majority female population and the minority male population has decreased, especially dramatically, in recent years. Additionally, using the compiled data and a linear regression model, predicted values were forecasted to continue this trend, with a general decrease in ED visits and a narrowing of the gap between females and males from 2022 to 2032. Conclusion As discussion and policy surrounding healthcare equity, primarily based on gender, becomes a more relevant topic, it is essential to discuss and analyze data to base new healthcare policy to ensure healthcare equality in all fields of medicine, including the ED and beyond. This study aims to identify and compare the difference in the frequency of ED visits between males and females to improve patient outcomes and further discussion regarding healthcare equity.

Responding to Patient Deterioration from Simulation to Practice: A Narrative Study of Undergraduate Nursing Students

ObjectiveThis study explores the impact of simulation-based training on nursing students' readiness to respond to patient deterioration in clinical practice. BackgroundWith limited in-hospital training opportunities, nursing educators seek alternative strategies to teach clinical skills. Simulation-based training offers a controlled environment for skill development and refinement. DesignA narrative research design was used to examine the experiences of senior undergraduate nursing students (n = 12) at a private university in the Western United States. MethodsData were collected through semi-structured interviews conducted via Zoom. ResultsThe study identified three key themes: the application of simulation experiences to real-world settings, the aspects of simulation training valued by students and the role of simulation in emotional regulation and coping. The findings highlight the importance of simulation training in preparing nursing students for clinical emergencies. ConclusionsSimulation training enhances clinical judgment and emotional resilience in nursing students, equipping them to handle emergent patient care. Integrating simulation into nursing curricula prepares students for clinical roles and nurse educators can enhance this by creating realistic clinical challenges in simulations.

The effect of intravenous ondansetron on QT interval in the emergency department

ObjectiveOndansetron, a 5HT3 receptor antagonist, is commonly used in emergency departments to treat nausea and vomiting. In 2011, the Food and Drug Administration (FDA) issued a warning that this medicine may cause QT prolongation, potentially leading to deadly arrhythmias. The objective of this study was to characterize the QT interval prolongation associated with ondansetron use in the Emergency Department. MethodsThis was a prospective, observational cohort study of adult patients who presented to the emergency department during a one-year period and were treated with intravenous ondansetron. We investigated the QT prolongation associated with dosages. ECGs were obtained before the medication and 5, 15, and 30 minutes after IV drug administration. Every QT measurement was recorded and compared to the zero point. The severity of drug-induced QT prolongation was determined according to the recommendations of the International Conference on Compliance (ICH). QTc prolongation was categorized as ‘negligible’ (<5 ms), ‘significant’ (>20 ms), ‘potential concern’ (>30 ms), or ‘definitely worrying’ (>60 ms). ResultsOf the 435 patients enrolled in the study, 60% (261 patients) were female and the mean age was 39 (±18). The QT prolongation peaked at the fifth minute and remained consistent at the fifteenth and thirty-first minutes. The maximum prolongation of the mean QT duration occured at the fifth minute (7.9 ± 18.1 ms). No patient revealed any problems with cardiac conduction. The prolonged QT interval was not related to the dose of ondansetron, but QT measurements were higher in the 30th minute in patients treated with 8 mg of ondansetron. The effect of ondansetron administration on QT prolongation was found to be above the ‘negligible’ but below the ‘significant’ value, according to the ICH recommendations. DiscussionIn this study, QT prolongation due to ondansetron administration was below the ‘important’ value according to the recommendations of the ICH. No cases of cardiac arrhythmia were reported in any of the partients. Thus, routine ECG monitoring in patients given ondansetron due to the risk of QTc prolongation does not seem cost-effective when evaluated together with additional factors such as its negative impact on emergency patient flow, waste of personnel and time, and increase in healthcare costs. In the absence of a known risk of cardiac arrhythmia, IV administration of 4 mg and 8 mg of ondansetron doses no risk of QT prolongation in the emergency population.