Triage Area Research Articles

Best clinical practice experience at University of Gondar Comprehensive specialized Hospital Emergency and critical care Medicine department, A Case Study Under a resource limited set up

Abstract Background The emergency department (ED) is unique unstable environment where someone faces unscheduled and undifferentiated diseased patients, stressed families, unsettled staffs and unequitable resources.UoGCSH is the oldest in the Ethiopia and the only referral hospital for more than 13 million people from the five-zone north-west Ethiopia with 950 beds capacity. During the 2020 G.C a proposal paper was submitted to the administration bodies of the college and the hospital. The proposal was suggesting short term, mid-term and long-term quality improvement segments implemented in institutionally convenient manner. Objective To describe the transformation of emergency and critical care medical services at University of Gondar Comprehensive specialized hospital from scratch to the current status. Method A descriptive case study design was applied to narrate critical care service transformation at UoG Comprehensive Specialized Hospital. Since this case study is a data review from gathered secondary data, desk reviews of the emergency department, quality directorate data review, and the annual audit report review, there was no need for IRB approval. Result and recommendation After a year of renovation, we were able to organize a newly refurbished emergency room having a triage area with adequate reception space, Red resuscitation area with 10 beds (considering patient overflow), Orange with 18 beds, Yellow with 10 beds and floater area, isolation room, decontamination room, ED laboratory, main store, disaster store and piped oxygen system to all beds. we have gone a long journey in bringing those promised practices into demonstrable practice and finally replicable prototypic best practice. Even though we paced extra miles in achieving this status. Standard emergency room work flow implementation enable us to control the day-to-day patient and attendant crowding that impedes the anticipated medical treatment outcome and result in a significant dissatisfaction.Despite this achievement the trauma center establishment and high-quality patient care is recommended.

Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study

BackgroundVital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.MethodsThis prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.ResultsA total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.ConclusionAmong the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

How Super Is Supertrack? Expediting Care of Fast-track Patients through a Pediatric Emergency Department.

Fast-track models decrease patient crowding in emergency departments (EDs) by redirecting low-acuity patients to an expedited care pathway. In 2016, this institution's pediatric ED created a fast-track pathway for patients evaluated in a rapid assessment triage area who needed further management in the primary ED. This "Supertrack" designation was intended for patients requiring up to 1 hour of additional care, though means of ensuring these patients were discharged within their anticipated timeframe were lacking. We aimed to increase the percentage of Supertrack patients discharged within 1 hour of their ED bed assignment from 17% to 50%. Interventions included the creation of objective Supertrack criteria, departmental-wide progress reports, personalized reminders, intake huddles, and documentation prompts. We visualized data from Plan, Do, Study, Act (PDSA) cycles with statistical process control charts to determine special cause variation. The percentage of Supertrack patients discharged within their anticipated timeframe increased from 17% to 27% without an increase in return ED visits. The average time Supertrack patients spent in the ED decreased from 121 to 103 minutes. Personalized reminders demonstrated a significant but short-lived improvement. We improved the flow of Supertrack patients by decreasing their length of stay and increasing how many were discharged within their anticipated timeframe. Limitations included an unexpected surge in patients with respiratory complaints and staffing and structural constraints preventing the designation of a discrete Supertrack assessment space with dedicated providers. These findings are helpful for institutions seeking to develop an effective fast-track model with limited space and resources.

Emergency triage nurses’ perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study

BackgroundTriage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome.ObjectiveTo describe triage nurses’ perceptions on caring behaviors and patient safety in the triage area.DesignStrauss and Corbin’s Grounded theory method was used to develop the model.MethodsThe study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin’s coding framework.ResultsThe analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category “Triage caring”, four subcategories were developed: (1) Assurance of triage nurses’ presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety.ConclusionsThe triage nurses’ perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient’s safety at the same time.Implications for the nursing fieldA better understanding of the importance of triage nurses’ caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients’ needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety.No patient or public contributionThe study’s design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.

Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study.

In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7% vs 8.8%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for "ease of task completion" (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), "satisfaction with completion time" (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and "satisfaction with support" (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3% vs 93.3%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED.

Correlation of Resilience, Stress, and Burnout in Doctors and Nurses Working at a Dedicated COVID-19 Hospital during Second Wave of COVID-19 Pandemic

Abstract Introduction: Research conducted during the first wave of COVID-19 in India and world over has highlighted its psychological impact among health-care workers (HCWs), which kindled the current study of the aftermath of the second wave among HCWs. Objectives: The objective was to study the correlation between demographic factors, resilience, burnout, and stress among doctors and nurses working at a dedicated COVID-19 hospital (DCH) during the second wave. Methodology: The DCH doctors (residents and faculty) and nurses willing to participate in the online survey using Google forms were assessed cross-sectionally using a semi-structured questionnaire for demographic factors and psychometric scales – abbreviated Nicholson McBride Resilience Questionnaire, abbreviated Maslach Burnout Inventory, and Perceived Stress Scale-10 to measure resilience, burnout, and stress, respectively. The data were analyzed using Chi-square test and Pearson’s coefficient for correlation. Results: Out of 169 voluntary participants, 24.9% had severe perceived stress, 21% had moderate-to-severe burnout, and 49.7% had exceptional level of resilience. Severe perceived stress was seen in the lower age group (P = 0.018) and more in graduates than in postgraduates (P = 0.044). Moderate-to-severe burnout was seen in unmarried (P = 0.02), in junior doctors (P = 0.021), in those working in intensive care unit, fever clinic, and triage area (P = 0.038), and in those living away from family (P = 0.014). Exceptional level of resilience was statistically significant in nursing staff (P = 0.026). There was a statistically significant correlation between perceived stress and burnout (P &lt; 0.001). Conclusion: The psychological impact of second wave was less among HCWs as compared to the first wave of COVID-19 pandemic.

Abstract TP64: Nursing Led Intervention Improves Thrombolytic Administration Time by Optimizing Emergency Department Code Stroke Pathways

Background: Timely efficient thrombolytic administration has been associated with better clinical outcome in acute ischemic stroke patients. Shortening the time from arrival to code stroke activation can lead to faster thrombolytic administration. Methods: Door to code stroke activation and door to needle times were calculated in consecutive code strokes in the emergency department (ED) from 1/2021-11/2021 Pre and 12/2021-12/2022 Post implementation of “Triage to CT” pathway. Our previous code stroke processes included initial evaluation by the triage nurse, followed by rooming and transferring the patient from triage to the ED room, and then to the CT suite. To improve our process, a staging area was set up where a gurney was placed adjacent to the triage area. This allows rapid assessment and activation of the code stroke protocol. ED staff were educated on sending the patient directly to CT after activation of code stroke by the triage physician. This process eliminates the need to room the patient prior to CT scan. Result: Median Door to Code stroke activation time was significantly lowered after the implementation of “Triage to CT” pathway (17 min to 11 min, respectively, p&lt;0.0001) Conclusion: In our study, “Triage to CT” pathway significantly shortened door to code stroke activation. Optimization of an emergency code stroke process by taking the patient straight to CT suite from the triage area decreases door to code stroke activation time and ultimately door to needle time.

Abstract TP53: Above Par on the Back Nine: Improving Triage of Posterior Circulation Stroke

Background and Purpose: Notoriously difficult to recognize, posterior circulation strokes (PCS) can be some of the most devastating. It is incumbent on the triage nurse to recognize these signs and symptoms. This project was developed to educate frontline ED staff on early identification of posterior strokes, decrease time to recognition, and improve outcomes. Methods: The community Primary Stroke Center (PSC) identified the need to improve recognition of PCS after a series of treatment-eligible patients were missed. A team was created including the directors of the PSC and associated Comprehensive Stroke Center (CSC), emergency room physicians, and nurses. A triage algorithm was created to capture as many strokes as possible without a glut of false positives. This included focal and non-focal signs of stroke. ANY sign of stroke should initiate the code stroke (CS) process provided that the presentation was within 24 hours of last known well, the presentation was sudden, and the symptoms were disabling to the patient. Once approved, the algorithm and education were provided to all patient-facing ED staff. Updates were added to huddle notes and a copy of the algorithm was made available at all triage areas. Data was collected retroactively for a total of 16 months, 8 months prior to the intervention and 8 months after. Results: - For all PCS the median time from arrival to initiation of CS improved from 9 minutes to 1 minute - For all PCS the median time from arrival to confirmation of stroke improved from 597 minutes to 249 minutes - Prior to intervention, only 60% of CS-eligible patients had a CS initiated, compared to 92% after - Ninety-day Rankin was from 0-2 in 86% of PCS patients prior to intervention compared to 100% after Conclusions: A clear triage process can maximize identification of PCS, increase capture of treatment-eligible patients, and decrease disability. A PSC with tele-stroke coverage and ongoing education improved identification of posterior circulation strokes and outcomes. Key takeaways for success include clear and concise code stroke algorithm, support from providers, and ongoing educational interventions. While this data is preliminary, we will continue to track and trend. Next steps should include education directed to EMS personnel in the field.

The effect of having a physician in the triage area on the rate of patients leaving without being seen: A quality improvement initiative at King Fahad Specialist hospital.

To evaluate the effect of the presence of a physician in the triage area on the number of patients who leave without being seen (LWBS) and some of the factors affecting emergency department (ED) crowding. This was a pre-post study carried out at King Fahad Specialist Hospital, Dammam, Saudi Arabia. The 3-month study, consisting of 7826 patients, was split into pre-physician and post-physician periods. Variables compared across these periods were the number of LWBS patients, length of hospital stay, time to physician, and time to disposition decision. Statistical analysis was carried out using R version 4.3.0. Our results showed that the presence of a triage physician significantly decreased the number of LWBS patients (p<0.001) and the time taken to encounter an ED physician (p<0.001). However, it did not have any significant impact on the length of hospital stay (p=0.5) or time to disposition decision (p=0.9). The appointment of a triage physician has streamlined patient flow and decreased LWBS rates in the ED, demonstrating the need for more thorough research in this area.

Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients?

There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.

Outcome of Poisoning and Associated Factors Among Patients Admitted at Referral Hospitals in Northwest Ethiopia, 2022: A Multicenter Retrospective Study.

Poisonings are the most common reason for visiting emergency departments and hospitals globally. Poisoning-related mortalities increase instantly, and it is a principal public health problem in Ethiopia. Hence, understanding the treatment outcome and identifying the associated factors is necessary to reduce poisoning-related mortality. To assess outcome of poisoning and associated factors among patients admitted to Referral Hospitals in Northwest Ethiopia, 2022. An institutional-based retrospective cross-sectional study was conducted in Western Amhara referral hospitals from June 2019 to May 2022. A total of 400 medical charts were reviewed. A stratified sampling technique was used. The data were entered into Epi Info version 7.2.1.0 and exported to SPSS version 25.0 software for analysis. Multivariable binary logistic regression analysis was used to determine factors associated with the outcome of poisoning. The mortality rate of poisoning was 18% (95% CI: 14.4-22.1). Being rural dwellers (AOR=2.65, 95% CI: 1.07-6.63), being unconscious (AOR=4.86, 95% CI: 1.89-12.48), not treated in triage area (AOR=4.64, 95% CI: 1.608-13.407), transport by Bajaj (AOR=6.78, 95% CI: 1.86-24.73), spo2 <95% (AOR=4.42, 95% CI: 1.19-10.78), and stayed >48 hours in the hospital (AOR=0.08, 95% CI: 0.02-0.36) were significantly associated with a mortality of poisoning. The mortality rate from poisoning was considerably high. Residence, level of consciousness, treatment at the triage area, mode of arrival, Spo2, and prolonged hospital stay were significantly associated. All stakeholders should focus on planning and improving care for patients with poisoning. Improving ambulance service in rural areas and providing treatment at the triage area for all patients are recommended.

A qualitative exploration of the facility-based trauma care for Road Traffic Crash patients in Bangladesh: When only numbers do not tell the whole story

ObjectiveBangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is...

Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit.

The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan. A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators. Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau. The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.

A-109 Application of Lean Manufacturing in Electrophoresis Test Processing in Order to Reduce Lead Time

Abstract Background There has been an increase on the demand for Protein Electrophoresis and Hemoglobin Electrophoresis exams over the past few years. This growth drew attention and motivated the laboratory’s Production Planning and Control (PPC) team to carry out a process flow analysis of the electrophoresis samples coming from the external units, which are responsible for approximately 60% of the total samples analyzed of these two exams. The study aimed to minimize waste throughout the process, optimize the use of resources, standardize continuous flows of activities, and reduce the Turnaround Time (TAT) of the samples in question, disseminating Lean culture and increasing the satisfaction of internal and external customers. Methods In order to reduce the TAT of electrophoresis exams from external units, the PPC team carried out on-site visits and revised the entire flow of processes related to these exams and others that could indirectly influence it, from collection and transport until the analyst’s signature and release of the result to the patient, mapping the entire flow covered by the samples and identifying possible important bottlenecks inherent to the activities, aiming at possible opportunities for improvement, through interviews, brainstorming, flowcharts and Design Thinking. Data such as the volume of monthly tests, percentage of external samples, TAT at the regional units, TAT at the Immunochemistry sector and total TAT were extracted from the laboratory’s automated data system and analyzed by the PPC team. With this, it was possible, through the Pareto analysis, to prioritize the obstacles to be overcome and focus on the main identified bottleneck, the amount of time for signing and releasing the reports, in addition to focusing on the random flow between the receiving and triage area and the processing technical area. Results Upon discovering that the greatest impact on processing time was located in the post-analytical phase of signing and releasing of the reports we suggested the capacitation of three extra analysts for the execution of the mapped action, the retraining of the technicians of the sectors responsible for the distribution of samples and supply of the machines and the standardization of a continuous flow between the areas, strengthening the Lean philosophy and the FIFO dynamics (First in—First out). Thus, we obtained a considerable decrease in the TAT of protein and hemoglobin electrophoresis, in which the total TAT of the operation was reduced by approximately 34% and the TAT referring to the time inside the Center of Technical Operations (CTO) by approximately 40%. Conclusion With the implementation of the above mentioned processes and the use of the Lean philosophy, the laboratory was able to considerably optimize the TAT of the Hemoglobin and Protein Electrophoresis exams, in addition to training employees to release results and enhance the standardization of receipt processes and distribution of these samples, with this, it was possible to optimize resources, increase the productivity of the sector, reduce the time of patient care and consequently maximize added value to the service.

Effect of COVID-19 on Emergency Service Trends

Purpose: The aim was to determine the variation in emergency service attendance occurring during the COVID-19 pandemic by assessing the monthly attendance distribution, monthly trends in emergency service attendance, hourly emergency service attendance trends and triage areas of patients attending the emergency service.&#x0D; Methods: This retrospective, descriptive research was completed based on records for 608,837 patients attending the emergency service of XX State Hospital from 11.09.2018 to 11.09.2021. Patient data for 18 months until the COVID-19 pandemic declaration on 11.03.2020 and 18 months after the pandemic declaration were assessed with the Joinpoint regression analysis program to analyze attendance. Analyses were completed at P

174 A silver lining: the identification of silver trauma at triage for older persons (&amp;gt;65) presenting to the emergency department

Abstract Background Trauma in patients over 65 (silver trauma), can result in serious injury from lower impact mechanisms. The NOCA Major Trauma report highlights that 58% of major trauma is a result of a fall from 2 metres or less and mortality increases with age and comorbidities. Failure to identify, rapidly assess and treat older persons who have suffered silver trauma results in prolonged emergency department stays with an increase in morbidity and mortality. We therefore, performed a completed audit cycle to assess the identification of Silver Trauma in our emergency department. Methods A focus group involving key stakeholders was established, including Emergency Physicians, nurses and members of the Gerontological Emergency Department Intervention team. An audit assessed patients triaged as ‘major trauma’ from October to December 2022. We established silver trauma guidelines for triage. Teaching sessions on the recognition of silver trauma were provided, daily briefings were given, and information leaflets were placed in all triage areas. A triage discriminator of ‘Silver Trauma’ was introduced to prompt recognition and review by clinicians. A full audit cycle was completed. Results Our initial audit (October to December 2022) revealed 25 patients triaged as ‘Major Trauma’ who were aged over 65. After the completion of the initial audit and implementation of measures, 122 patients were triaged as ‘Silver Trauma’ between January 20th and March 31st. We identified that 59% (N = 72) were due to falls from 2 meters or less. Other mechanisms of injury included unwitnessed fall (21% N = 25), syncope (7% N = 8), fall from height (11% N = 13) and Major Trauma (3% N = 4). Seventy-one (58.19%) were admitted and 51 (41.80%) were discharged home. Conclusion This audit demonstrates that departmental education and implementation of a triage discriminator has significantly improved the recognition of silver trauma within the ED setting.

Management of Mass-Casualty Incidents in Nepal: A Qualitative Case Study of Three District Hospitals in Nepal.

The frequency of disasters world-wide has significantly increased in recent years, leading to an increase in the number of mass-casualty incidents (MCIs). These MCIs can overwhelm health care systems, requiring hospitals to respond quickly and effectively, often with limited resources. While numerous studies have identified the challenges in managing MCIs and have emphasized the importance of hospital disaster preparedness, there is a research gap in the preparedness level and response capacities of district hospitals in Nepal. This study attempts to fill this gap by understanding the perception of hospital staff in managing MCIs in district hospitals of Nepal. A qualitative case study was conducted in three district hospitals in Nepal. Semi-structured interviews were conducted with the hospital personnel, using an interview guide. An inductive thematic analysis was carried out to understand their perception on the most recent MCI management. Three themes emerged from the data analysis: enablers in MCI management, barriers in MCI management, and recommendations for the future. Use of multiple communication channels, mobilization of entire hospital teams, mobilization of police in crowd control, presence of disaster store, and pre-identified triage areas were the major enablers that facilitated successful MCI management. Nonetheless, the study also revealed challenges such as a lack of knowledge on MCI response among new staff, disruptions caused by media and visitors, and challenges in implementing triage. This study emphasized the importance of hospital disaster preparedness in managing MCIs and highlighted the significance of overcoming barriers and utilizing enablers for an efficient response. The findings of this study can provide the basis for the Ministry of Health and Population Nepal and district hospitals to plan initiatives for the effective management of MCIs in the future.

Emergency Preparedness Of Nurses And Midwives In Accra, Ghana

Nurses are often the first responders in hospital emergencies, a greater emphasis on emergency preparedness in nursing education, as well as ongoing training and capacity building, is necessary. The study focused on the emergency preparedness of nurses and midwives at the Police Hospital in Accra of Ghana. It considered the knowledge of nurses and midwives on emergency and disaster preparedness; the roles of the nurses and midwives on emergency and disaster preparedness; and relevant training programmes of the nurses midwives on emergency preparedness and management. The study employed descriptive survey of the quantitative approach. Questionnaire was employed for 133 nurses and midwives that were selected with the aid of simple random sampling technique. The data was analysed using frequencies, percentages, means and standard deviations with the aid of SPSS software version 26. About 60% of respondents indicated they have training on emergency/disaster preparedness in the last 5 years. Close to 74% also revealed that emergency/disaster planning is a preparedness on what might be needed to be done, how to be done before and after. Most (64%) of respondents indicated they have adequate knowledge on safety precaution and management during emergency and disaster occurrence, however, few respondents (34.6%) indicated that the Police Hospital have bed capacity, equipment and logistics to cater for patients in the occurrence of an emergency/disaster. The police hospital has a triage area and has a chain of command during a large scale emergency event. About 75.2% of respondent indicated they know how to triage in a large-scale and almost 79.7% of respondents know how to assess and respond to site safety issues for self, co-workers and affected people during a large-scale emergency event. About 91.7% agreed that there is a need for periodic training and lecture for the nurses and midwives whiles 88.7% indicated that emergency and disaster stimulation drills should be conducted frequently to adequately prepare the nurses and midwives for emergency events. The nurses and midwives had a moderate degree of perceived knowledge in emergency/disaster management. They were well-informed about their roles in emergency/disaster preparedness. Despite their limited knowledge and skills, the respondents were enthusiastic about emergency/disaster training and simulations

Emergency department nurses’ competences: implementing a personal dossier for nurses onboarding, skills maintenance, and quality audit

Emergency Departments (EDs) are among the most challenging clinical settings for nurses.EDs are complex settings, including patients with various clinical severity levels, every typology of medical and surgical specialties, fast organizational responses, a triage area to identify the clinical priorities to access a medical visitation, and simultaneous emergency codes to be managed.Therefore, the issue of acquiring and maintaining adequate competencies to manage the delivery of nursing care in a multifaceted setting such as ED is central.&#x0D; Orientation and onboarding programs with very different characteristics in terms of content, duration, and delivery methods are present worldwide. These programs can include clinical skills self-assessment, structured learning opportunities, e-learning, development of core skills, portfolios.&#x0D; The possibility of integrating different educational strategies to gain knowledge with time spent in specific clinical areas to increase experience is the winning way to obtain the growth and maintenance of ED nurses’ competencies.&#x0D; In this paper, we report on the experience (currently in progress) related to the ongoing performance evaluation of ED nurses’ activities during 12 months in the Emergency Department of Careggi University Hospital.In particular, a printed annual “Professional dossier” was designed with two-fold aim. The staff nurse holder of the booklet can handle a realistic summary of his/her activities, case mix, and time spent in the diverse clinical areas of the ED, comparing these data with opportune standards provided to make adequate comparisons and pinpoint the professional improvements that are needed. The nurse coordinator and nurse manager can use nurses’ personal dossiers to know the realistic competencies load in the ED, balance the work shifts with adequate skill mix, program the rotation of nurses in the different clinical areas during the year to ease the maintenance of experience and expertise, and have a photograph of some important performance indicators for hospital personnel evaluation.

Violence in the Emergency Department: What Can We Do?

Violence in healthcare settings is a problem around the world, with hospital emergency departments (EDs) being the most common sites. The most important step in preventing violence is to determine the causes and characteristics of the problem. However, there is not enough information in the literature about the particular areas of EDs in which violence occurs. We aim to produce results that can contribute to violence prevention activities by gathering detailed information about violent incidents in EDs and the intensity of this violence. Our study was planned as a retrospective and descriptive study at a tertiary emergency medicine clinic. Our data include "code white" data between January 1, 2015, and December 31, 2019. The characteristics and types of violence were recorded and categorized. We evaluated 141 incidences of severe violence reported during the study period. We determined that 55.2% of the violence was directed at physicians and 21.3% at nurses. Verbal violence was by far the most common type of violence, comprising 98.6% of the cases. We found that the violence cases occurred in examination rooms, observation areas, and triage units of the ED (58.2%, 24.1%, and 11.3%, respectively). We determined that violence in the ED is most common after standard working hours, and the most frequent exposure to violence is in examination rooms, observation areas, and triage areas. These findings may be useful in determining preventive measures in EDs, where violence is most common.