Walk-in Patients Research Articles

Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system

AimsThis process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). Design & MethodsSemi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. ResultsThrough a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. ConclusionBased on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.

Early Reservation for Follow-up Appointments in a Slotted-Service Queue

Shall Follow-up Appointments Be Booked in Advance? Appointment systems are ubiquitous, especially in healthcare. By looking into a large data set with over 1.6 million appointments, we observe that many doctors booked a follow-up appointment at the end of their meeting with their patients. This strategy ensures that the patients would follow up but at the risk that the patient may not show up and the appointment ends being wasted. We develop a slotted-service queue model to study if and when such a strategy should be used in three representative appointment systems, respectively. In an open access system, it is optimal to never use this strategy. In a traditional appointment system that allows patients to book in advance, it is optimal to apply this strategy to some patients. While in a hybrid system with both walk-in patients and patients with appointments, whether to use this strategy depends on the load balancing between the two patient queues.

Pathways to the emergency department - a national, cross-sectional study in Sweden

BackgroundSwedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients’ pathways to the ED is not documented in any registry.The aim of this study was to provide a national overview of pathways, degree of medical acuteness according to triage, chief complaints, and hospital admission rates for adult patients (≥18 years) visiting Swedish EDs during 24 h.MethodsA national cross-sectional study including all patients at 43 of Sweden’s 72 EDs during 24 h on April 25th, 2018. Pathway to the ED, medical acuteness at triage, admission and basic demographics were registered by dedicated assessors present at every ED for the duration of the study. Descriptive data are reported.ResultsA total of 3875 adult patients (median age 59; range 18 to 107; 50% men) were included in the study. Complete data for pathway to the ED was reported for 3693 patients (98%). The most common pathway was self-referred walk-in (n = 1310; 34%), followed by ambulance (n = 920; 24%), referral from a general practitioner (n = 497; 1 3%), and telephone referral by the national medical helpline “1177” (n = 409; 10%). In patients 18 to 64 years, self-referred walk-in was most common, whereas transport by ambulance dominated in patients > 64 years.Of the 3365 patients who received a medical acuteness level at triage, 4% were classified as Red (Immediate), 18% as Orange (very urgent), 47% as Yellow (Urgent), 26% as Green (Standard), and 5% as Blue (Non-Urgent).Abdominal or chest pain were the most common chief complaints representing approximately 1/3 of all presentations.Overall, the admission rate was 27%. Arrival by ambulance was associated with the highest rate of admission (53%), whereas walk-in patients and telephone referrals were less often admitted.ConclusionSelf-referred walk-in was the overall most common pathway followed by ambulance. Patients arriving by ambulance were often elderly, critically ill and often admitted to in-patient care, whereas arrival by self-referred walk-in was more common in younger patients.

Balance Disorders: A Review of Patients at a Specialized Vestibular Clinic

Introduction: With recent advancements in vestibular assessments, new ancillary tests can assist clinicians to better understand underlying cause of a balance problem. The recently established specialized vestibular clinic in Sultan Ahmad Shah Medical Centre @IIUM is equipped with these tests. This study aimed to determine the prevalence of the different diagnoses of balance disorders in a specialized vestibular clinic in Kuantan, Malaysia. Materials and Methods: This is a retrospective review of 121 walk-in patients over an 18-month period at a specialized Vestibular Clinic in Sultan Ahmad Shah Medical Centre @IIUM. The variables analysed in this review include the age, gender, ethnicity, diagnoses, and total number of visits before diagnoses were achieved. Results: Meticulous history taking, focused otorhinolaryngological examination and detailed vestibular assessment through the specialized vestibular clinic helped us in reaching a conclusive diagnosis. The most common cause of balance disorders in our review was Benign Paroxysmal Positional Vertigo (BPPV), constituting 41.3% of the cases. Among the canals, the posterior canal is the most affected (70%) and is usually treated with Epley manoeuvre. Other common diagnoses include Vestibular Migraine, Meniere’s Disease and Vestibular Neuritis. Conclusion: Vestibular clinics play a vital role in helping to pinpoint the accurate diagnosis of patients with balance disorders.

Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study.

BackgroundIncreasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments.ObjectiveThe purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED.MethodsThe study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs).ResultsOf 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all.ConclusionsThe app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis.Trial RegistrationGerman Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909

Improving patient satisfaction and outpatient diagnostic center efficiency using novel online real-time scheduling

We develop a novel online real-time scheduling algorithm with applications for healthcare diagnostic centers to deal with walk-in patients based on a set of constraints on the sequence of tests and resources. The problem is especially significant at healthcare centers in developing and emerging nations, such as India, where appointment schedules do not work. Within this realistic context, our objective is to improve patient satisfaction by reducing waiting time and improve diagnostic center performance through better utilization of the constrained resources. We propose a Mixed Integer Linear Programming (MILP) formulation to represent diagnostic centers as a Flow and Open Shop, to capture the system dynamics of the Flexible Hybrid Shop Scheduling Problem. We then develop a novel Online Genetic Algorithm (OGA) capable of solving real life large scale problems, as Open Shop scheduling problems are NP-hard. The developed OGA is first validated for small instances against a theoretical lower bound and the MILP model using CPLEX solver for flow time and makespan. The OGA is then empirically validated with data collected from two diagnostic centers of different sizes and configurations. For both centers, the developed OGA shows significant improvement compared to the simulation model. This research offers an important contribution to both literature and practice as it is one of the first to model the patient scheduling problem as an online real-time process. Implementing the developed OGA would help diagnostic centers significantly improve time estimates, thus reducing actual patient time and improving the efficiency of the system. Most importantly, the OGA is generalizable beyond healthcare to a broad range of environments that share Hybrid Shop characteristics.

Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

Assessing Knowledge about Antibiotic Resistance and the Prevalence of Self- Medication with Antibiotics among Community Pharmacy Clients in Lagos State.

Background: Knowledgeable self-medication has its advantages, however, without adequate information, it can be dangerous and harmful. Self-medication with antibiotics (SMA) is common in Nigeria and has led to increased cases of drug resistance, threatening the future relevance of antibiotics. Objectives: To determine the prevalence of SMA among walk-in patients in pharmacies in Lagos state, assessing their level of knowledge about antibiotics, antibiotic resistance, and conditions for use. Methods: The research involved three community pharmacies in Ikeja, Apapa, and Agege areas of Lagos representing high, medium, and low-income areas, respectively. Willing participants above 15 years of age were administered a questionnaire with questions aimed at assessing how often they engage in SMA and their familiarity with factors causing antibiotic resistance. Data collected was analyzed using descriptive statistics and results were presented in tables. Chi-square was used to determine levels of association between variables with P-values significant at < 0.05 at 95% confidence interval. Results: Among the respondents, 35.1% indulged in SMA while 64.5% purchased their antibiotic medications through a healthcare professional’s recommendation. Over two-thirds of the respondents had basic knowledge of antibiotic use with a similar fraction being familiar with the existence of antibiotic resistance and factors that contribute to its development. Conclusion: A majority of the respondents were knowledgeable regarding antibiotic use and factors that could lead to antibiotic resistance however, many of them still practiced self-medication with antibiotics. Health promotional activities are encouraged for further enlightenment of the public so as to reduce the widespread prevalence of this challenge.

Self-Referred Walk-in (SRW) versus Emergency Medical Services Brought Covid-19 Patients.

Objective:To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, respiratory distress, PO2 at arrival, admission length and in-hospital death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients. Results:There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant and lower than SRW group (p<0.05). Despite the SRW patients, respiratory distress was associated with lower survival in EMS group (p<0.05). Days passing the symptom’s beginning was significantly different between EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in patients higher than 75 years old in both groups (p<0.05). Higher PO2 at arrival was associated with lower mortality rate of Hazard Ratio of 0.959 (p<0.001) and 0.903 (p<0.001) in EMS and SRW groups, respectively. The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group. Conclusion:It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.

Mortality of hospital walk-in trauma patients: a multicenter retrospective cohort study.

AimTo investigate the characteristics of patients who visited the emergency department by themselves after experiencing trauma and subsequently died, and to identify the prognostic factors of mortality in such patients.MethodsAdult patients with trauma visiting the emergency department by themselves between 2004 and 2019 in Japan were identified using a nationwide trauma registry (the Japan Trauma Data Bank). The characteristics of patients who died were compared with those who survived, and multivariable logistic regression analysis was used to determine the independent association of each preselected variable with in‐hospital mortality (end‐point).ResultsOf the 9753 patients eligible for analysis, 4369 (44.8%) were men, and the median age was 75 years. Of these patients, 130 (1.3%) died in the hospital. The following factors had a significant association with in‐hospital mortality: age, male sex, Charlson Comorbidity Index (CCI) 3–4 and ≥5 with CCI = 0 as a reference, circumstances of injury (free fall and fall at ground level), Glasgow Coma Scale score, Shock Index ≥ 0.9, severe injuries of the head, abdomen and lower extremities, and Injury Severity Score ≥ 15.ConclusionsSeveral risk factors, including older age, male sex, higher CCI, circumstances of injury (free fall and fall at ground level), lower Glasgow Coma Scale score, higher Shock Index, and severe injuries of the head, abdomen, and lower extremities, were identified as being associated with the death of trauma patients visiting the emergency department by themselves. Early identification of patients with these risk factors and appropriate treatment may reduce mortality posttrauma.

COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context:COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector.Aims:This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges.Settings and Design:A descriptive cross-sectional study of radiology facilities in Nigeria.Subjects and Methods:Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail.Statistical Analysis Used:Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables.Results:Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail.Conclusions:There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial

IntroductionThe purpose of this study is to incorporate behavioural economic principles and user-centred design principles into a multicomponent intervention for the management of uncontrolled hypertension (HTN) in chronic kidney disease...

Contact-Free Monitoring of Pulse Rate For Triage of Patients Presenting to the Emergency Department.

The evaluation of a patient's pulse rate (PR) plays a key role in emergency triage and is commonly measured in a contact-dependent way. Our aims were to evaluate a camera-based prototype application (CBPA) measuring PR in an emergency department (ED) as an alternative to the current contact-dependent method of pulse oximetry and to determine the correlation between CBPA and pulse oximetry in measuring PR. We simultaneously measured PR with CBPA and pulse oximetry as a reference method on a large group of ED walk-in patients. We then estimated correlation and agreement between the two methods, as well as the corresponding 95% confidence intervals. In a convenience sample of 446 patients, the correlation between CBPA and pulse oximetry in measuring PR was 0.939 (95% confidence interval [CI] 0.927-0.949) and the intraclass correlation was 0.939 (95% CI 0.927-0.949). Our study found that CBPA seems to be a viable alternative to the current method of measuring PR at triage. ClinicalTrials.gov identifier: NCT03393585.

Abstract 13260: Relationship Between Localization of Myocardial Asynergy and Presence of Pathological Q Wave in Synthetic Posterior Lead Electrocardiogram

Background: Synthesized posterior lead derived from 12-lead ECG can represent ST elevation in posterior acute myocardial infarction with high accuracy. However, the validity of pathological Q wave (Q) in synthesized lead ECG remained unclear. Objective: To investigate the relationship between localization of ventricular wall motion abnormality (Asynergy) and presence of Q in synthetic V7-V9 lead (synV7-V9). Subjects: Consecutive 1319 walk-in patients (68±13y, Male 67.5%, LVEF 64.0±10.4%) who underwent ECG and transthoracic echocardiography (TTE) were extracted from our database. Method: (1) Posterior lead: synV7-V9 was obtained from synECi18 system (Nihon Kohden) and V2-V5, II•aVF, and I•aVL•V6 leads were obtained from 12-lead ECG. (2) Asynergy was detected as increased wall motion score on 16-segments from TTE and classified into coronary perfusion regions. We analyzed the relationship between Q in synV7-V9 and patient characteristics, ECG parameters, or TTE parameters. Results: Wall motion abnormality was observed in 217 cases (16.5%). Q in synV7-V9 was detected in 79 cases (6.0%), and 38 cases out of them showed asynergy in any coronary perfusion site (Figure. A). In order to clarify relationship between Q in synV7-V9 and asynergy, wall motion score of 16-segments were compared in Presence of Q in synV7-V9 limited group and Non Q in all lead group (Figure. B). As a result, in the former, the scores in basal to mid on inferior to infero-lateral wall were found to be significantly higher. Logistic regression analysis for presence of Q in synV7-V9 limited showed asynergy in RCA to LCx region (OR 4.5, 95%CI 1.6-13.0), in RCA region (OR 4.0, 95%CI 1.4-11.0), in LCx region (OR 5.8, 95%CI 1.2-27.7), male (OR 2.6, 95%CI 1.2-6.0), right bundle brunch block (OR 3.2, 95%CI 1.4-7.3) remained as significant factors. Conclusion: Present study suggests Q in posterior lead using synthesized ECG can help diagnose myocardial scarring in RCA to LCx region including posterior wall.

Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study.

BackgroundA vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care.ObjectiveOur organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs.MethodsIn this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed.ResultsBackground work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress.ConclusionsThrough this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability.Trial RegistrationClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718International Registered Report Identifier (IRRID)DERR1-10.2196/31951

Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies.

(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes.

Security in Emergency Departments: Spatial Analysis of the Physical Environment

Emergency departments (EDs) are one of the most complex clinical areas in the healthcare system and one of the most dangerous workplaces. Evidence shows that healthcare professionals who work in EDs are more prone to violence from patients and visitors than those working in other healthcare settings. While many studies have highlighted organizational and operational policies to minimize the risk of violence against healthcare workers, very few studies have focused on the role of facility design. This research aimed to (1) gain an understanding of environmental design features in EDs that may impact the occurrence of violet events, and (2) propose potential environmental design scenarios for future examination of ED design through primary research. Peer-reviewed and gray literature on ED design were reviewed, and case examples of ED facility design projects were identified from online sources and were spatially analyzed. Findings from the literature suggested that entry zones of EDs, including entrance doors and vestibules for walk-in patients, reception areas/desks, and waiting areas are associated with the most security issues. Based on this finding, the spatial analysis was limited to the entry zones. The design examples were categorized based on their spatial patterns and visibility properties. This typology of entry layouts helped with developing three design scenarios with different levels of visibility. The design scenarios represent the most common layouts of entry design in ED facilities. A walk-through video of each scenario is developed for future research. A future study can identify the perceived security level of each scenario by presenting them to healthcare workers and security professionals working in EDs. This research highlights the importance of interior environmental design in improving security and reducing the risk of violent behavior against healthcare workers in EDs.

IMPACT OF EMERGENCY DEPARTMENT TRIAGE ON TIMELY ECG ACQUISITION

<h3>BACKGROUND</h3> Percutaneous coronary intervention (PCI) is the standard of care reperfusion therapy in the management of STEMI. Timeliness is critical to the effectiveness of PCI and shorter times to reperfusion are associated with decreased morbidity and mortality. To expedite reperfusion, guidelines recommend STEMI patients should receive an ECG within 10 minutes from initial presentation, represented as first medical contact to electrocardiogram (FMC-to-ECG) time. Various factors have been suggested to impact FMC-to-ECG time including triaged acuity, measured by the Canadian Triage and Acuity Scale (CTAS). Designations of CTAS 1 and 2 indicate higher triage levels demanding priority attention over CTAS 3, 4 or 5. <h3>METHODS AND RESULTS</h3> This is a retrospective observational study of three emergency departments (ED) within a non-PCI capable health system. Walk-in patients with an ECG suggesting STEMI from 2017-2019 were identified (n=276). Charts were reviewed and only true walk-in patients with a final diagnosis of STEMI and data necessary to calculate FMC-to-ECG times were included (n=165). Furthermore, all patients with a chief complaint of chest pain presenting to the three emergency departments during 2017-2019 were also identified to establish a baseline CTAS triage rate. The primary objective of this study is to investigate if ED triage acuity is associated with timely ECG in walk-in STEMI patients. 95% of STEMI patients were triaged as CTAS 1 or 2 compared to 79.7% of all patients presenting with a complaint of chest pain. 55% of STEMI patients with a CTAS 1 or 2 designation received a timely ECG compared to 50% of STEMI patients with a CTAS 3, 4 or 5 designation. Statistical analysis of proportions between groups was performed by using Chi squared tests of independence or Fisher's exact test where appropriate. <h3>CONCLUSION</h3> Walk-in STEMI patients were significantly more likely to receive a higher priority CTAS designation of 1 or 2 compared with any patient presenting with chest pain. Despite the appropriate triage designation, only 55% of CTAS 1 or 2 patients received timely ECGs and they were not more likely to receive a timely ECG over lower priority CTAS designations. Taken together, these findings suggest the presence of a system-related delay in FMC-to-ECG time. Interventions designed to improve the ability of patients to receive ECGs and activate STEMI management pathways at the level of ED triage may be helpful in identifying STEMI patients earlier, thereby expediting their reperfusion time.

PREVALENCE AND FACTORS ASSOCIATED WITH CATARACT AMONG RURAL COMMUNITY ADULTS IN NEGERI SEMBILAN

‘Klinik Pakar Mata Bergerak’ (KLiP Mobile), translated to specialised ophthalmology mobile clinic is a programme that provides ophthalmology care in the rural community of Negeri Sembilan. This study was conducted to determine the prevalence of cataracts and its associated factors among rural adults in Malaysia through an outreach programme of specialised ophthalmology services by KLiP Mobile. This is a cross-sectional study carried out from January 2016 until March 2018 and was conducted in rural areas of all seven districts in the state of Negeri Sembilanvisited by the KLiP Mobile. Universal sampling was applied to all adults attending the mobile clinic. The participants are those who were referred by the government community clinics and walk-in patients. The total number of participants in this study was 1480. The mean (SD) age for the study population was 56 (16.9), by which majority were Malay (n = 1220, 82.4%) and female (n = 809, 54.7%). Most of them received either primary (n = 604, 42.4%) or secondary education (n = 577, 40.5%). The majority of participants were categorized into the low-income group, with a monthly income of less than RM 3,000 (n = 1118, 92.4%). The prevalence of cataracts in the study population was 28.6%. In the multivariate analysis, factors significantly associated with cataracts were being male, having no formal education, race and suffering from hypertension. The prevalence of cataracts in rural areas is considerably high. This study highlights the need for baseline information for future study or as the main reference by the policymakers for policy development related to improving vision and eye care among the populations in Malaysia. &#x0D;

Use of telehealth and outcomes before a visit to the emergency department: a cross-sectional study on walk-in patients in Switzerland.

An increasing number of patients are using telehealth before contacting the healthcare system. If we are to optimise future telehealth strategies and adequately respond to patient needs, we need to know more about the frequency and characteristics of telehealth use. Our objectives were (i) to investigate whether patients use telehealth before consulting the emergency department (ED), (ii) to compare patients with and without use of telehealth, and (iii) to investigate adherence, confidence and satisfaction. A survey was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. Eligible patients were questioned about their use of telehealth before current presentation, during 30 shifts from 23 October to 15 December 2019. A total of 183 (43.9%) of 417 surveyed patients used telehealth, with the telephone being the most commonly used modality, especially among elderly patients. Patients using telehealth were more likely to be male (53.5%, p = 0.001) and were similar in age to non-users. Telehealth users tended to be better educated. Telehealth was predominantly used for semi-urgent non-traumatic diseases that did not lead to hospitalisation. All age groups expressed satisfaction with telehealth, trusted the recommendations and adhered to them. The main reason for &quot;non-use&quot; of telehealth was lack of knowledge. Lack of knowledge about telehealth opportunities and barriers in specific patient groups should be addressed to include all patients, and thus to exploit telehealth&rsquo;s many advantages.