Priority Code Research Articles

A linguistic landscape study of shop signs on Barkhor Street in Lhasa

ABSTRACT This study adopts a mixed-method approach to analyze the characteristics of the linguistic landscape in Barkhor Street, the attitudes of tourists, shop owners, and residents towards it, and the strengths and weaknesses of linguistic landscape design there. Findings showed that: 1) In terms of the presentation of linguistic landscape, the combination of ‘Tibetan + Chinese’ appears most frequently, with Tibetan being a priority code present in them. Moreover, different types of shops employ different marking methods for shop signs. 2) Overall, the audience expressed satisfaction with the linguistic landscape, with a preference for using the ‘Tibetan + Chinese + Pinyin’ combination. Most respondents suggested using Tibetan as a priority code and graphemic marking as a marking method. 3) The linguistic landscape design has the advantages of preserving and promoting Tibetan culture and boosting economic development. However, it also has the disadvantage of weak information function and a monolithic presentation of the linguistic landscape due to related language policies. 4) Furthermore, the study found that economic factors significantly influence the choice of language combinations and marking methods in the linguistic landscape. Language policies are a double-edged sword, and language, economy, and culture form an interconnected cycle.

Trend of accesses to the Emergency Department of a Teaching Hospital of Tuscany due to bronchiolitis in 2018-2023: new challenges.

Acute bronchiolitis is one of leading causes of lower respiratory tract infection and hospitalisation in children less than one year old worldwide. The aim of our study is investigating the impact of bronchiolitis in children paediatric to the Emergency Department (ED) of Teaching Hospital (AOUS), Santa Maria alle Scotte of Siena, Tuscany (Italy). A retrospective observational study was conducted on the accesses performed at the ED of the AOUS of Siena by children under 18 years of age suffering from bronchiolitis from September 2018 to April 2023. There were 36,031 patients between 0 and 18 years old in the Emergency Department, 383 of which presented bronchiolitis (age 4.8 months C.I.:3.5-6 months.; 54% male). Those who accessed the ED with a higher priority code were more likely to be subsequently admitted (O.R.:2.6; C.I.:1.3-5.1; p < 0.01). Those who accessed the ED with symptoms of bronchiolitis during the weekend were less likely to have been sent from community medicine services or professionals (O.R:0.1; C.I:0.0-0.5; p < 0.001). Children below 1 year old were more likely to access the ED with respiratory distress symptoms (O.R.:2.6; C.I.:1.5-4.3; p < 0.001). Finally, those who accessed the ED with bronchiolitis were more likely to be admitted than those who accessed for other conditions (O.R:24.5; C.I.:19.4-31; p < 0.001). It is necessary to invest protocols integrating hospital services and community medicine in order to achieve a timely diagnosis and to reduce the accesses to the ED of children presenting mild, non-severe form of bronchiolitis in order to avoid the overload of hospital services.

Epidemiological and clinical features of bronchiolitis after the COVID-19 outbreak: comparison of two epidemic seasons.

The first aim of this study was to compare Pediatric Emergency Department (PED) admissions for acute bronchiolitis during the 2022-2023 season to those of the season 2021-2022. The secondary aim was to assess the difference in the recurrence of bronchiolitis episodes in the same patient between the two seasons. This is a retrospective, observational, cross-sectional study conducted at the PED of IRCCS A. Gemelli University Polyclinic Foundation (Rome, Italy). We included all children aged between 0 and 2 years admitted to PED with the diagnosis of bronchiolitis. We compared features of seasons 2021-2022 and 2022-2023. The median age of children enrolled during the 2022-23 season was 5 months (IQR: 2-8) compared to 7 months (IQR: 2-14) in the previous one (P=0.02). We observed in the last season a higher number of children admitted to PED with a high priority code and an increased therapeutic use of high-flow nasal cannula and inhaled adrenaline. During the 2022-23 season we found 31 (12.8%) children presenting more than one episode of bronchiolitis in the same epidemic season, compared to 16 (7.6%) children in the previous season (P=0.048). Our data emphasize that the epidemiological features of bronchiolitis after COVID-19 outbreak have changed and are still evolving.

Construction of Language Landscape in Newly Built Ancient Cities: A Case of Yizhou Ancient City, China

Introduction: As China has increasingly ushered in the era of mass tourism, ancient city or town tourism has gained popularity across the country, and a significant number of new scenic spots in ancient towns have been constructed. However, these lovely spots typically rely on conventional tourist and catering. Many tourists focus more on the issue of how to study old cities’ cultural ambiance and internal features on a deeper level, as well as the depth of its connotations. This paper examined the language landscape creation of the Yizhou Ancient City in Linyi, China, to delve into the language landscape building of newly built ancient town tourist attractions. Methodology: The data collection stage was mainly completed through field investigation, using digital cameras to shoot various language signs in the scenic spot. The data statistics stage mainly included random interviews, research objective determination, and data statistical analysis. Results: The results showed that the language signs in the scenic spot were mainly monolingual, supplemented by bilingual signs. There were two languages, Chinese and English, in which Chinese was the priority code, while English was a marginalized code in the language landscape of the scenic spot. The management department of scenic spots played a decisive role in constructing language landscapes. However, the managers of scenic spots and shop operators had not yet realized the economic value of language landscapes. The language landscape of Yizhou ancient City has the following problems: insufficient construction of a diversified language landscape, weak design sense of language landscape, lack of cultural connotation of language landscape, lack of innovation of language landscape construction and so on. Conclusion: It is suggested that the scenic spot management department should pay attention to different aspects in the future. They should pay attention to the potential value of language landscape construction, the unique linguistic landscape brand of the scenic spot should be constructed, and the multi-language needs of tourists.

Validity of the Manchester triage system in the prioritization of patients with transient global amnesia in the emergency department

AbstractBackgroundThe Manchester Triage System (MTS) is one of the most widely used and studied triage systems in emergency departments (ED). MTS does not have a specific presentational flow chart for patients with transient global amnesia (TGA). The goal of this study was to determine the adequacy of priority code assignment for patients with TGA presenting at the ED and triaged using the MTS.MethodsThis is a single‐center observational retrospective study from January 01, 2013 to June 31, 2020. All patients with a medical diagnosis of TGA were considered. An audit was conducted on these triages to assess the correct application of MTS by the triage nurses. Correct triage was considered as a patient classified as yellow.ResultsDuring the study period, 216 patients with a diagnosis of TGA were considered. Of these 49.5% were classified as yellow, 13.0% were undertriage and classified as green or blue and 37.5% were overtriaged and classified as orange or red. The audit demonstrated that 98.8% of overtriaged patients and 57.1% of undertriage patients were triaged incorrectly. In addition, in 38 patients the triage nurse confused TGA with an acute neurological deficit suggestive of stroke or transient ischemic attack.ConclusionThe present study demonstrates an inability of MTS to correctly stratify patients with TGA. The results of the present study indicate the need for a specific flow chart for patients with neurological problems to improve the performance of MTS.

Investigation and Perspective on the Construction of Language Landscape in Scenic Spots of Ancient Cities: Take the Juguo Ancient City in China as an Example

As China gradually enters the era of mass tourism, people's tourism consumption demand has changed from low-level and focusing on sightseeing to high-quality, diversified and leisure vacations, which puts forward more requirements for the deep, connotational and high-quality development of tourism. Given that the research on language landscape in tourism is still relatively insufficient, this study tries to investigate the construction of the language landscape in the Juguo ancient city in Shandong Province from the perspective of the tourism language landscape in China. The study found that the language signs in the scenic area are mainly monolingual signs, supplemented by bilingual and trilingual signs; There are three languages in the scenic spot, Chinese, English and Korean, among which Chinese is the priority code, while English and Korean are marginalized codes in the scenic spot language landscape. The management department of scenic spots plays a decisive role in constructing language landscapes, but the business operators have not yet realized the economic value of language landscapes. There are problems in constructing the tourism language landscape in scenic spots, such as insufficient construction of a diversified language landscape, non-standard translation of language signs, and lack of design sense and characteristics of signs. In the future, scenic spot management departments should pay attention to the value of language landscape construction, meet the multilingual needs of tourists, highlight the style and characteristics of language landscape, and regularly carry out language landscape investigation and updates.

The acute bronchiolitis rebound in children after COVID-19 restrictions: a retrospective, observational analysis.

Bronchiolitis represents the main cause of illness and hospitalization in infants and young children. The aim of this study was to compare the Pediatric Emergency Department (PED) admissions for bronchiolitis during the post-COVID (Coronavirus disease) period to those of previous seasons and to analyze their etiology during COVID and post-COVID period. We compared demographics, clinical and microbiological data of children admitted to PED with bronchiolitis between September 2021 and March 2022 (post-COVID period) to the previous seasons (COVID and pre-COVID period). During the post-COVID period the bronchiolitis season started earlier than usual, with a peak reached in November 2021; a gradual reduction was subsequently observed between December 2021 and January 2022. Our data showed a prevalence of High Priority code in children admitted to the PED with bronchiolitis during the post-COVID period (61.4%) compared the pre-COVID period (34.8%) (p=0.00). Also regarding the hospitalization of these patients, we found a major rate of hospitalization during this epidemic season (p=0.035). In addition, only 4 (1.5%) of the tested children resulted positive for SARS-CoV-2 and all of them were admitted to PED during the post-COVID period. The search for the other respiratory viruses showed during the current season a prevalence of respiratorysyncytialvirus(RSV) (60.2%), followed by Human Rhinovirus (30.1%). The post-COVID period was characterized by an early and short-term peak in acute bronchiolitis, with an increased rate of hospitalization. In addition, SARS-CoV-2 infection was rarely cause of bronchiolitis in children under 2 years old.

Practising prioritisation: exploring variation in applying a clinical pharmacy risk stratification tool

ObjectivesTo evaluate the use of a risk stratification tool and explore the contributing factors to variation in practice by clinical pharmacists.MethodsThe quantitative phase was a prospective evaluation of adherence to...

P277 SECRET BEYOND THE DOOR. TRIAGE ANALYSIS AND RECOGNITION AT THE DOOR OF ELDERLY PATIENTS WITH PULMONARY EMBOLISM WHO ARRIVE IN THE EMERGENCY ROOM. THE REAL–LIFE EXPERIENCE OF 5 YEARS IN THE EMERGENCY ROOM

Abstract Background The range of symptoms of pulmonary embolism is wide and its recognition difficult. Purpose to analyze the efficiency of triage in the EP. Methods Single–center retrospective observational study, on all geriatric patients (&amp;gt;75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2015 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes. Results We enrolled 247 patients, all in need of hospitalization. 44% came for dyspnea, 17% for chest pain, 16% for signs of DVT, 8% for syncope. 5% had only atypical symptoms (dizziness, general malaise, low–grade fever, neurological symptoms …). 45% had concomitant deep vein thrombosis. 50% showed alteration of the ECG tracing, 49% alteration of the shock index. Only 4% showed hypotension, 13% tachycardia and 8% desaturation. 39% arrived with their own vehicle. 32% was allocated to the area with low intensity of care, 68% to the area with medium–high intensity of care. As regards the priority code for the visit, 0% received a non–urgency code (white code or code 5), 27.9% a minor urgency code (green code or code 4) and 3.6% a high priority to the visit with assignment to low intensity of care (low intensity yellow or code 3). 63.15% received an emergency code (urgency or code 2) and 5.3% an emergency code (red code or code 1). The severity code at discharge, given on clinical criteria, was a low severity code (white or green) in 18% of cases, while 76% was considered high severity (urgency, yellow code) and in 6% for very high gravity (red code). 34% showed massive PE, 32% showed organ damage. 41% were considered to be at high risk of short–term mortality according to European guidelines, 8% required intensive care and in–hospital mortality was 7.7%. Under triage is 32%. Conclusions The population that arrives in ED due to pulmonary embolism presents extremely varied symptomatological pictures, and an overall high degree of clinical risk and care and therapeutic complexity in spite of the symptoms complained of and vital parameters. Under–riage remains a real problem for ED for this category of patients.

Hot spots and burning times: A spatiotemporal analysis of calls for service to establish police demand

Establishing police demand is important to optimally allocate scarce police resources in space and time. To contribute to the existing knowledge on the optimization of policing and crime prevention strategies worldwide, we examine the spatiotemporal pattern of calls for service (CFS), with a focus on the urgency of the calls (as measured by the police priority codes), in Antwerp (2017–2020), Belgium. To disentangle the space-time pattern of the priority codes, we apply the average nearest neighbour statistic, global and local Moran's I, Getis-Ord Gi*, and emerging hot spot analysis. Our results demonstrate that the spatial, temporal, and space-time patterns of the priority codes differ and that more urgent CFS are more demanding in terms of allocated police vehicles than less urgent CFS. Based on the findings of this paper, we recommend to include priority codes in future police patrol routing solutions to make patrol strategies more realistic. An important aspect will be to increase/decrease the number of available units depending on the spatiotemporal pattern of the CFS per priority code. Instead of only working with fixed shifts, there is a need to deploy peak shifts during times of peak demand.

Nurse decision making in triage cose assignment: a qualitative descriptive study

Given the importance of improving Emergency Department (ED) quality of care and patient satisfaction and safety, analyzing how nurses make decisions in the triage process may help healthcare organizations in developing effective and safe EDs and in supporting healthcare staff. The present study was therefore conducted to explore factors that contribute to nurses' decision-making in the triage process. Two Focus groups with 20 nurses have been conducted and content data analyses performed following a descriptive qualitative approach. Three main aspects tend to affect nurses' decision making in the triage process and therefore influence priority code assignment: the patient's condition (signs and symptoms, risk of adverse clinical evolution, presence of frailty conditions), the organizational setting (patients flow, relationship with medical staff, stressful environment, support from the organization) and the nurse's experience (experience with similar situations, intuition, burden of responsibility). Nurses tend to balance adherence to protocols with appropriate responsiveness of the ED department and tend to seek peer feedback regarding to the priority code assigned. Triage is a complex process, consisting of many factors, resulting from contingent situations that vary continuously. These elements intersect in a process that continuously tends to affect the decision.

Can triage correctly stratify cardiogenic syncope in patients admitted to the emergency department for a transitory loss of consciousness?

Abstract Background The Manchester Triage System (MTS) is the most popular validated triage system in Europe. It allows the stratification of the large volume of patients admitted to the emergency department (ED) into five increasing risk categories, assigning higher priority to the most serious patients [1]. Purpose To evaluate the effectiveness of the MTS in stratifying patients admitted to the ED for syncopal transitory loss of consciousness (TLOC) and correctly identifying cardiogenic syncope. Methods All patients consecutively evaluated in the ED between 1 January 2017 and 1 July 2019 for a TLOC episode were retrospectively considered. TLOCs were retrospectively classified according to the guidelines of the European Society of Cardiology (ESC) [2]. Syncopal TLOCs were separated from non-syncopal TLOCs. Demographic and baseline characteristics of all patients were recorded. Patients were divided into two groups for comparison according to the MTS code assigned at triage: blue/green/yellow (low priority) versus orange/red (high priority). Considering only syncopal TLOCs, the primary study outcome was the presence of cardiogenic syncope as defined in the ESC guidelines. The performance of the MTS was evaluated using a 2x2 table, deriving sensitivity, specificity and accuracy, and through analysing receiver operating characteristic curves. Sensitivity analyses were also performed on patient subgroups. Results A total of 2,291 patients with TLOC were considered (83% low priority versus 17% high priority). Of these, 90.2% (2,066/2,291) presented syncopal TLOC. Among the patients with syncopal TLOC, 85.7% (1,770/2,066) were assigned a low priority code, while 14.3% (296/2,066) were given high priority. Patients with a high priority code were older (median age 66 versus 77 years; p&amp;lt;0.001), presented more altered vital signs (p&amp;lt;0.001), presented more associated symptoms (p&amp;lt;0.001) and presented more cardiac comorbidities (p&amp;lt;0.001). Overall, cardiogenic syncope was present in 7.5% (154/2,066) of patients with syncopal TLOC. Of these, 55.2% (85/154) were stratified with a low priority code, while 44.8% (69/154) were stratified with a high priority code (p&amp;lt;0.001). The MTS presented a sensitivity of 44.8%, a specificity of 88.1% and an accuracy of 84.9%. The area under the receiver operating characteristic curve for the prioritisation of cardiogenic syncope through MTS codes was 0.683. Sensitivity analyses on specific subgroups of patients, such as those with or without other associated symptoms in triage or major cardiac comorbidities, revealed comparable performance. Conclusions Syncopal TLOC is an insidious clinical condition. Currently, limited information is available about triage systems and the correct prioritisation of syncope. Although the MTS has demonstrated good performance for other cardiac symptoms, its performance is not acceptable for syncopal TLOC [3]. Improvements are needed to optimise triage systems for syncopal TLOC. Funding Acknowledgement Type of funding sources: None.

Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study.

Introduction: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biała Podlaska and Chełm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. Materials and Methods: We analysed medical records of 1200 older patients treated by METs in Biała Podlaska and Chełm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biała Podlaska and the Medical Rescue Station in Chełm (Independent Public Complex of Health Care Facilities). Results: A total of 92.5% of medical emergency service interventions took place at the patient’s home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient’s sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. Conclusions: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biała Podlaska and Chełm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

New Early Warning Score: EMS Off-Label Use in Out-of-Hospital Patients.

Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization.

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study.

BackgroundCOVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders.MethodsImpact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs.All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019.Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children.Findings16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344).InterpretationAdmissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.

A fully automated inpatient transport system

BACKGROUND: The transport of the inpatients to and from locations inside the hospital can vary in complexity depending on the patient location, status, and logistical needs. Most transport systems have not developed at the same speed as other medically related technologies. We conducted a pilot study of a new automated transport system for patients within the hospital. METHODS: Our innovative system was introduced in January 2020. We present a retrospective case review of all in-patient transport request during April 15, 2020 through May 30, 2020 at the Shaare Zedek Medical Center, Jerusalem, Israel. The system is fully automated and works via smartphone and electronic medical record integration. Transfer requests are processed on the basis of priority, proximity, and availably. RESULTS: During the study period there were 15, 581 transfer requests. Mean times to hospital destinations ranged from 9:25 to 28:02 minutes. Overall, mean times were quicker for emergency and surgical services. Trip times by priority code were likely influence by unmeasured confounders. There were no reported patient identification adverse events. Peak requests occurred during 0900-1500, and at the beginning of the week. CONCLUSION: Our automated in-patient transfer system appears to be efficient, safe, well received, and capable of servicing our large tertiary care medical center. Future controlled studies are needed to assess efficacy, adverse events, and clinical outcomes.

How to improve the Triage: A dashboard to assess the quality of nurses’ decision-making

This paper presents a dashboard for assessing the quality of Triage decision-making process in the assignment of the priority code to patients arriving at an emergency department. The quality is assessed through performance indexes aimed at measuring both the nurses’ accuracy and the presence of nurses’ shared behavior in the Triage assignment process. The theoretical perspective of the cognitive heuristic, that is a cognitive shortcut strategy to make decisions, is the framework to design performance indexes of the dashboard. The dashboard has been tested in two Emergency Departments. We gather the data input through the submission to 54 nurses of a questionnaire, simulating 25 patients’ scenarios. The dashboard reveals a disparity between nurses in priority level assignment. This disparity depends on nurses’ capacity in disregarding some information and in considering the right cue. We find the presence of sharing behaviors and inclination to over or under assessment by nurses. This performance analysis, integrated with the nurses’ reasoning in assigning the priority code, can address the management in designing improvement actions at individual level and at the organizational one. In addition, the application to two Emergency Department confirms the influence of organizational aspects in the individual decision process.

Performance of the Manchester Triage System in patients with dyspnoea: A retrospective observational study

BackgroundBetween 1% and 7.5% of patients admitted to the emergency department (ED) suffer from dyspnoea. The Manchester Triage System is one of Europe’s most used triage systems considering five levels to prioritize patients in the ED: level 1 (red), immediate; level 2 (orange), very urgent; level 3 (yellow), urgent; level 4 (green), standard; level 5 (blue), non-urgent. With this study we aimed to evaluate the performance of the Manchester Triage System in patients with dyspnoea. MethodsWith this retrospective, observational study we analysed data from 4′076 patients with dyspnoea accessing the ED in one Italian hospital between January 1, 2017 and June 30, 2019. To determine the sensitivity and specificity we computed the area under the curve (AUC) of the receiver operating characteristics (ROC) comparing the sensitivity and specificity for each of the five priority codes and seven-day mortality. ResultsA total of 3.6% (n = 145) of the patients died within seven days after access to the ED. From the patients dying within seven days, 6.2% (9/145) had a blue or green priority code, 17.9% (26/145) had a yellow priority code and 75.9% had an orange or red priority code. A high priority code (orange or red) had a sensitivity of 75.9%, a specificity of 66.1%, a PPV of 7.6% and a NPV of 98.7%. The AUC was 0.734 (CI 95% 0.695–0.773, p < 0.001). ConclusionsThe Manchester Triage System showed acceptable sensitivity and negative predictive value in patients with dyspnoea, yet a low specificity related to the risk of death. The system is safe, resulting in a low under-triage rate for death. Improving the clinical assessment during nurses’ triage (e.g. considering clinical history and auscultation of lungs) and prospective validation studies with surrogate endpoints is needed in this population.

How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone

ObjectiveTo quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. MethodsWe retrospectively analysed all consecutive admissions to ED from 1 January to 9 April in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. ResultsThe number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (95% confidence interval −0.41/−0.19; Beta = −0.8; P < .0001). The average access per day was significantly lower after 10 March 2020 (1.5 ± 1.1 vs 6.5 ± 2.6; P < .0001), compared to reference period. From 11 March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; P = .001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; P = .02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta = 0.88; P < .0001) during 2020. ConclusionUrological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.

A Smart Priority-Based Traffic Control System for Emergency Vehicles

Unwanted events on roads, such as incidents and increased traffic jams, can cause human lives and economic loss. For efficient incident management, it is essential to send Emergency Vehicles (EVs) to the incident place as quickly as possible. To reduce incidence clearance time, several approaches exist to provide a clear pathway to EVs mainly fitted with RFID sensors in the urban areas. However, they neither assign priority to the EVs based on the type and severity of an incident nor consider the effect on other on-road traffic. To address this issue, in this paper, we introduce an Emergency Vehicle Priority System (EVPS) by determining the priority level of an EV based on the type and the severity of an incident, and estimating the number of necessary signal interventions while considering the impact of those interventions on the traffic in the roads surrounding the EV's travel path. We present how EVPS determines the priority code and a new algorithm to estimate the number of green signal interventions to attain the quickest incident response while concomitantly reducing impact on others. A simulation model is developed in Simulation of Urban Mobility (SUMO) using the real traffic data of Melbourne, Australia, captured by various sensors. Results show that our system recommends appropriate number of intervention that can reduce emergency response time significantly.