Public Hospital Emergency Department Research Articles

Investigation of Clinical and Socio-demographic Characteristics of Suicide Cases Admitted to Emergency Department

OBJECTIVE: Suicide is a preventable cause of death. Good analysis of case data is essential for the prevention of suicide. The aim of this study is to investigatethe clinical and socio-demographic characteristics of suicide cases admitted to emergency department. MATERIALS and METHODS: This is a descriptive study performed retrospectively. The files, suicide forms and electronic records of patients who admitted to a public hospital emergency department between 1 January 2015 and 31 October 2018 due to suicide or attempted suicide were analyzed. RESULTS: Ninety-two of the 168 cases with appropriate records were analyzed. Women represented 65.2% of the suicide cases, 69.6% were aged 15-29, and 40% were students. The most common method of suicide was drug-toxic substance use (84.8%), and the most common reasons for suicide were family problems (26.1%) and mental illnesses (16.3%). No previous history of attempted suicide was present in 89.1% of cases, while 13% had a history of medication use due to psychiatric disease within the previous six months. CONCLUSION: Detailed analysis of cases must constitute the first step in suicide prevention. The quality of data obtained from hospitals’ electronic databases and patient records therefore needs to be increased.

The Culture of Emergency Department in a Public Hospital

The research revolves around the culture of emergency department. Hospital emergency departments make a distinctive subculture inside the healthcare, in an atmosphere of social interaction and variation. Every organization can create its own values. Hospitals or other primary care centers having emergency departments usually. Initially, the emergency room was planned as a treatment room for emergency cases such as road accident cases or other acute conditions in which life is on risk. This department later specialized in the treatment of emergency cases which were presented with no consultation, by an emergency vehicle or any transport available at that time. It was taken place in the Emergency department of Tehsil Headquarter Hospital Pind Dadan Khan. The patients were interviewed regarding their experience, their time of arrival, the medical personnel who received them and their satisfaction level with the provided treatment and care. The other method which was used is participant as observer. The most consistently observed finding associated with higher levels of satisfaction, was the patient-oriented care provided by doctors, nurses and paramedic staff. Doctors and nurses who spent more time with the patient, had better communication skills, showed more empathy and treated the patients within 5 minutes of arrival in the emergency resulted in more patient satisfaction. On the basis of these characteristics, the calculated number of satisfied patients turned was more than the patients who were not satisfied. However, major emergency patients responded that they would not prefer emergency departments of public sector hospitals of Tehsil Pind Dadan Khan for future because major emergency services were not available.

Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study

BackgroundStudies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury.MethodsParticipants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ≤4/50 and global perceived effect of ≥4/5.ResultsTwo-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18–1.62). EBC was not significantly associated with recovery.ConclusionsGuideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.

Analysis of different public policies through simulation to increase total social utility in a healthcare system

Public and private hospitals are seen to co-exist in several countries and they have different levels of service, waiting times and prices. Public hospitals, in general, are cheaper, but more crowded and offer lower quality service than private ones while private ones are underutilized because of the higher payments required for their services. These differences among hospitals affect patients’ choices in hospital selection and result in different levels of satisfaction in the community. Appropriate subsidy mechanisms can be developed to balance the capacity utilization of both sectors and to improve overall access to healthcare. The objective of this study is to develop an estimate of the magnitude of this improvement and differential effectiveness of various policies in achieving this improvement. For this purpose, we develop a simulation model that includes all the emergency departments of main public and private hospitals in a certain region of Turkey. We analyze the effects of different public policies on patients’ preferences regarding hospital choices and the results of these choices on social utility and public healthcare spending. Different capacity decisions, contracting and subsidy mechanisms are proposed and the optimal system parameters are determined under these mechanisms over this simulation model. After the validation and verification of the simulation model, several scenarios are designed and executed to increase social utility, decrease government expenses, improve patient satisfaction level and decrease waiting times. We compare the proposed scenarios based on multiple objective functions and present numerical results for different scenarios in this system.

Are service and patient indicators different in the presence or absence of nurse practitioners? The EDPRAC cohort study of Australian emergency departments

ObjectivesTo evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators.Design and settingCohort study comprising ED presentations...

004 Vestibular event monitoring in the emergency department

IntroductionAcute vertigo is often accompanied by ictal-nystagmus which may assist with diagnosis. We examine the merits of a structured assessment combined with vestibular event-monitoring in the Emergency Department (ED).MethodsWe undertook a structured clinical assessment and video-nystagmography in 220 non-consecutive patients presenting to a public-hospital ED with acute vertigo, during a 10-month period. The records of 115 consecutive vertiginous patients who underwent standard-assessment were compared.ResultsFor the structured assessment group: 54% presented with acute vestibular syndrome (AVS), 24% with episodic spontaneous vertigo (EVS), and 20% with recurrent positional-vertigo (RPV).For AVS (n=119), most common diagnoses were vestibular neuritis (34%), stroke (34%) and vestibular migraine (13%). Nystagmus slow-phase velocity (SPV) for VN, stroke and VM were 11±5.5o/s, 5.6±2.5o/s, 5.4±5.9o/s; Mean ipsilesional video-head impulse gains were 0.51±0.29, 0.89±0.20 and 0.96±0.13. For EVS(n=53), diagnoses included vestibular migraine (63%), Meniere’s Disease (11%) and others (26%). Nystagmus SPV was 5.4±3.6o/s, 7.6±6.3o/s, 4.1±1.5o/s. In RPV (n=43), common diagnoses were posterior-canal BPPV (66%), horizontal-canal BPPV (23%), migraine (7%). Positional nystagmus SPV profile showed Peak SPV of 42.5o/s, 77.6o/s, 20.64o/s and Time-constants of 6.52s, 22.51s, 34.56s for Posterior-canal BPPV, Horizontal-canal BPPV and Atypical Positional-Vertigo. A final diagnosis was reached in 96% of patients.In the ED control group, only 77% were separated into spontaneous or positional-vertigo. A diagnosis was provided in 57% and was concordant with the history and examination in 34%.ConclusionVestibular event-monitoring and structured clinical assessment secured a diagnosis in 96% of cases compared with 34% for the control group, reinforcing its merit.

Analysis of factors influencing length of stay in the Emergency Department in public hospital, Yogyakarta, Indonesia

BackgroundsThe increasing demand for emergency care may cause prolonged Emergency Department length of stay that has an impact on quality of care. In Indonesia, factors influencing Emergency Department length of stay are difficult to determine. The purpose of the study was to identify factors that contributed to length of stay at tertiary hospital Yogyakarta, Indonesia. MethodsA descriptive study was conducted with a cross-sectional, retrospective design. Participants (n=139) were patients aged 18 years or over who presented to Emergency Department at tertiary hospital, over seven consecutive days. Data were gathered by reviewing patients’ notes using modified data collection tool and by measuring the average time in each stage of Emergency Department patient journey. Mann–Whitney and Kruskal–Wallis tests were utilised to analyse data. ResultsThe median Emergency Department length of stay was 330min. The acuity level, specialist consultation and need for admission were associated with increased Emergency Department length of stay (p<0.05). Laboratory turn around time (median 58min) and waiting for bed availability (median 167min) contributed to prolonged length of stay, for discharged and admitted patients, respectively. ConclusionsThis study assists in understanding factors that most significantly influence Emergency Department length of stay in an Indonesian hospital and will inform policy makers in development of strategic plans to improve Emergency Department patient flow.

Human resource allocation in an emergency department

Purpose The complexity and interdisciplinarity of healthcare industry problems make this industry one of the attention centers of computer-based simulation studies to provide a proper tool for interaction between decision-makers and experts. The purpose of this study is to present a metamodel-based simulation optimization in an emergency department (ED) to allocate human resources in the best way to minimize door to doctor time subject to the problem constraints which are capacity and budget. Design/methodology/approach To obtain the objective of this research, first the data are collected from a public hospital ED in Brazil, and then an agent-based simulation is designed and constructed. Afterwards, three machine-learning approaches, namely, adaptive neuro-fuzzy inference system (ANFIS), feed forward neural network (FNN) and recurrent neural network (RNN), are used to build an ensemble metamodel through adaptive boosting. Finally, the results from the metamodel are applied in a discrete imperialist competitive algorithm (ICA) for optimization. Findings Analyzing the results shows that the yellow zone section is considered as a potential bottleneck of the ED. After 100 executions of the algorithm, the results show a reduction of 24.82 per cent in the door to doctor time with a success rate of 59 per cent. Originality/value This study fulfils an identified need to optimize human resources in an ED with less computational time.

Epidemic Thunderstorm Asthma

Introduction:On November 21 and 22 of 2016, Victoria witnessed an unprecedented epidemic thunderstorm asthma emergency event in size acuity and impact. This scenario was never exercised nor contemplated. The event resulted in a 73% increase in calls to the Emergency Services Telecommunications Authority and 814 ambulance cases in the six hours from 6 pm on November 21, 2016. A 58% increase in people presented to public hospital emergency departments in Melbourne and Geelong on November 21 and 22, 2016 (based on the three-year average). 313 calls were made to the nurse on call from people with breathing, respiratory, and allergy problems (compared to an average of 63 calls for the previous month). Tragically, ten deaths are linked to this event.Methods:A substantial amount of work has been completed, much of which goes towards addressing the Inspector-General for Emergency Management recommendations following a review of the event, including: Release of an epidemic thunderstorm asthma campaign and education programs which were rolled out across Victoria for the community and health professionals from September through November 2017;Development of a new epidemic thunderstorm asthma forecasting system on 1 October 2017 and updated warning protocols during the 2017 grass pollen season;Implementation of a Real-time Health Emergency Monitoring System to alert the department of demands on public hospital emergency departments on the system; andIntroduction of a new State Health Emergency Response Plan in October 2017 to improve coordination and communications before and during a health emergency.Discussion:The presentation will concentrate on the lessons learned more than two years down the track from the event in November 2016.

Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study

BackgroundResearch exploring multi-disciplinary emergency department (ED) clinicians’ perceptions of their working environment is limited, although exposure to occupational stressors is frequent. This study describes ED clinicians’ perceptions of their working environment, occupational stressors and their use of coping strategies. MethodsA cross-sectional descriptive study was conducted in 2017 at two Australian public hospital EDs. Nursing and medical staff completed a print-based survey of 100 items, which included three scales and a demographic questionnaire. Responses were analysed using descriptive statistics and regression analysis. ResultsDoctors and nurses (n = 241) completed the survey (response rate 45%). Workload featured as a major factor in perception of the working environment and was a frequently occurring stressor. Death or sexual abuse of a child was the highest rated stressor, despite relative infrequency of exposure. When coping strategies were adjusted for sex, female respondents were more likely to use negative strategies such as blaming themselves (Odds Ratio, OR 4 [1.6–9.7]; p < 0.01) and less likely to use positive strategies such as exercise (OR 0.2 [0.1–0.6]; p < 0.01). ConclusionsWhile stressors were similarly rated among the diverse group of clinicians, the ways in which they reported coping varied. Further research is required to facilitate design of staff support strategies.

Ambulance diversions following public hospital emergency department closures.

To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private. Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007). We match public and private (nonprofit or for-profit) hospitals by distance and size. We use random-effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals. N/A. Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P<0.001). Hospitals declaring diversions have lower ED occupancy (P<0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P<0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P=0.022). Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.

Uncompleted Emergency Department Care (UEDC): a 5-year population-based study in the Veneto Region, Italy.

SummaryIntroductionUncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure.MethodsThis was a cross sectional study on anonymized administrative data in a population-based ED database.ResultsA total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7‰, with a slightly higher rate of AMA than of LWBS (15.3‰ vs 13.4‰). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other). Some characteristics of the hospital structure, such as the type of hospital and the volume of patients managed, could also be associated with UEDC.ConclusionCases of UEDC, which may involve patients who leave AMA and those who LWBS, differ considerably from other cases managed at the ED. The present findings are important for the purpose of planning and staffing health services. Decision-makers should identify and target the factors associated with UEDC to minimize walkouts from public hospital EDs.

Profile and outcome of patients with emergency complications of renal failure presenting to an urban emergency department of a tertiary hospital in Tanzania

BackgroundRenal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Our aim was to describe the profile, management strategies and outcome of renal failure patients presenting with indications for emergent dialysis to an urban Emergency Department (ED) in a tertiary public hospital in Tanzania.MethodsThis was a prospective cohort study of consecutive patients (age ≥ 15 yrs) presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2017 to February 2018. All patients with renal failure and complications requiring acute dialysis were included. A structured data collection sheet was used to gather demographics, clinical presentation, management strategies and outcomes. Data were summarized with descriptive statistics. Logistic regressions were performed to determine factors associated with receiving dialysis and with mortality.ResultsWe enrolled 146 patients, median age was 49 years (IQR 32–66 years), and 110 (75.3%) were male. Shortness of breath 67 (45.9%) and reduced urine output 58 (39.7%) were the most common presenting complaints. The most common complications were hyperkalemia 77 (53%), uremic encephalopathy 66 (45%) and pulmonary edema 54 (37%). All patients were hospitalized, and 61 (42%) received dialysis. Overall mortality was 39% (57 patients); the mortality in non-dialysed patients was 53% vs. 20% (p < 0.0005) in those receiving dialysis. 54% of patients with health insurance were dialyzed, compared to 39% who paid out of pocket (adjusted OR = 0.3, 95%CI: 0.1–0.9). Patients (≥55 years) were less likely to be dialysed (adjusted OR = 0.2 [0.1–0.9]). Independent predictors of mortality were vomiting (OR = 6.2, 95%CI: 1.8–22.2), oliguria (OR = 3.4, 95%CI: 1.2–9.5), pulmonary edema (OR = 4.6, 95%CI: 1.6–14.3), creatinine level > 1200umol/L (OR = 5.0 95%CI: 1.4–18.2), and not receiving dialysis (OR = 8.0, CI: 2.7–23.5). Female sex had a lower risk of dying (OR = 0.13, CI: 0.03–0.5).ConclusionsIn this ED in LIC, acute complications of renal failure created a need for ED stabilization and emergent dialysis. Overall in-hospital mortality was high; significantly higher in undialysed patients. Future studies in LICs should focus on identification of categories of patients that will do well with conservative therapy.

Burnout and job satisfaction among emergency and intensive care providers in a public hospital.

New technologies and inadequate management of work might have negative impact on the mental health of workers. To investigate factors associated with the prevalence of burnout and levels of job satisfaction among emergency department and intensive care providers in a large public hospital. Cross-sectional study with 91 healthcare workers, who were administered the self-report questionnaires Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and Job Satisfaction Scale (JSS20/23). The sample was predominantly composed of women (58.2%), married workers or with a stable partner (52.8%), having attended graduate studies (75.8%) and with average age 37 years old. Twenty-five percent of the participants exhibited emotional exhaustion and dissatisfaction with the work environment and hierarchical relationships, and 66% had already thought of leaving the profession. Allocation to intensive care unit, lack of professional growth opportunities, dissatisfaction with hierarchical relationships, nursing profession, and having thought of leaving the profession explained 55% of the prevalence of emotional exhaustion. Positive correlation between emotional exhaustion and job dissatisfaction was the earliest identifiable indicator of burnout. Periodic evaluations for early detection and prevention are important to reduce occupational disorders, and consequently improve the quality and safety of care delivery.

The impact of unintentional alcohol-related falls on emergency departments

BackgroundAlcohol is the cause of many injury presentations to the emergency department. There has been little research on alcohol-related falls in the broader adult population, which represent a substantial proportion of the total alcohol-related injury presentations to emergency departments. MethodsA population-based retrospective analysis of public hospital emergency department presentations for Victoria for 2003–2015 was undertaken. ResultsAlcohol-related fall presentations have increased by 96% over the 13-year period, a rate of growth exceeding non-alcohol-related falls, all ED presentations, and Victorian population growth. Alcohol-related fall presentations are most prevalent in the 20–24 year age group, and among males. The severity of alcohol-related fall presentations is greater than non-alcohol-related fall presentations, based on triage scale ratings and admission rates, with head injuries being the most frequent type of injury. ConclusionsPublic health warnings about the risks of alcohol-related fall injuries and the need to seek medical treatment for head injuries in particular are necessary to raise awareness among younger people. Emergency staff vigilance with neurological assessments is needed for early diagnosis of traumatic brain injury in alcohol-related fall presentations to help prevent adverse outcomes.

Cross-sectional study on emergency department management of sepsis.

Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators. Sixteen of the 18 public EDs in Hong Kong participated in the study. Among various time-critical medical emergencies such as major trauma, sepsis was perceived by the interviewees to be the leading cause of in-hospital mortality and the second most important preventable cause of death. However, only seven EDs reported having departmental guidelines on sepsis care, with four adopting the Quick Sequential Organ Failure Assessment score or its modified versions. All responding EDs reported that antibiotics were stocked within their departments, and all EDs with sepsis guidelines mandated early intravenous antibiotic administration within 1 to 2 hours of detection. Reported major barriers to optimal sepsis care included lack of knowledge and experience, nursing human resources shortages, and difficulty identifying patients with sepsis in the ED setting. There are considerable variations in sepsis care among EDs in Hong Kong. More training, resources, and research efforts should be directed to early ED sepsis care, to improve patient outcomes.

Waiting time in public hospitals: case study of total joint replacement in Hong Kong

Purpose The purpose of this paper is to review the causes of long waiting time in Hong Kong public hospitals and to suggest solutions in the service, organisational, systems, financial and policy perspectives. Design/methodology/approach The paper is a review of waiting time of public hospital services. Total joint replacement, which is one of the elective surgeries in public hospitals, is presented as a case study. Findings The average waiting time of semi-urgent and non-urgent patients in the accident and emergency departments of public hospitals is two hours, and that of specialist outpatient (SOP) clinics is from 1 to 144 weeks. For total joint replacement, it is from 36 to 110 months. Measures like Government subsidisation programme for the replacement surgery and employing adequate physiotherapists, Chinese medicine practitioners, clinical psychologists and nurses to reduce the waiting time are suggested. Issues concerning the healthcare system of Hong Kong, such as structural reform, service delivery model, primary care, quality and process management, and policy reviews, are also discussed. Originality/value The ‬over-reliance of public services has resulted in long waiting time in public hospitals in Hong Kong, particularly in the emergency services and SOP clinics. However, the consequences of long waiting period for surgical operations, though much less discussed by the media and public, can be potentially detrimental to the patients and families, and may result in more burdens to the already stretched public hospitals‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

Emergency department models of care in Queensland: a multisite cross-sectional study.

Objective The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Methods Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Results Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. Conclusion There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. What is known about the topic? MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. What does this paper add? The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. What are the implications to practitioners? A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.

Analysis of the use of point-of-care ultrasonography in Emergency Departments in public hospitals in Catalonia. ECURCAT Study

The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia. Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians. The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-of-care ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007). Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department.

Victimization of health professionals in Bucharest service relations and social work relationships

Workplace violence in the health sector has become an international social problem since the end of the 20th century. This concern is much more recent in Romania; few data are still available. This research aims to assess the extent of the phenomenon in this national context. The analysis is based on 207 questionnaires collected from doctors, nurses and care assistants from different departments and establishments in Bucharest, with an overrepresentation of the emergency department of public hospitals for its crystallization of conflicts. This research shows the prevalence of professional experience of victimization in the health sector (more than one respondent in two claims to have suffered violence at least once in the past year). This experience is massively built in the service relationship; the conflicts of perspective that manifest themselves there are experienced as violence when they undermine the exercise of the profession, as it is designed by the professionals. The results also show the significant role of the organization and its functioning in the expression victim. The more the organization is perceived negatively, the more often the expression victim is frequent. The service relationship is thus more than the question of the interactions between professionals and users and makes sense in the specificities of the context, which is itself crossed by fundamental reforms. This background helps to understand the importance of workplace conflict, accounting for more than one in five victimizations. More broadly, role conflicts, even if they are not all denounced as violence, contribute to shaping a lived experience, weighing on the victim expression of health professionals. © 2018, Bucharest University of Economic Studies Publishing House. All rights reserved. PDF | Victimization of health professionals in Bucharest service relations and social work relationships. Available from: https://www.researchgate.net/publication/325364196_Victimization_of_health_professionals_in_Bucharest_service_relations_and_social_work_relationships [accessed Jun 25 2018].