Impact of emergency short-stay unit opening on in-hospital global and cardiology indicators

RATIONALE, AIMS AND OBJECTIVES

Emergency short-stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in-hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in-hospital indicators at a whole general hospital and at its cardiology division (CARD).

METHODS

We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in-hospital indicators at the hospital and CARD before (2007-2011) and after (2011-2018) SSU opening.

RESULTS

After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P < .001) and in-hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P < .001) and CARD (50 [12] vs 54 [12], P = .004). In parallel, monthly in-hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P = .019), but not at the hospital (712 [73] vs 700 [104], P = .54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P < .001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P = .002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward.

CONCLUSIONS

SSU opening improved ED crowding, but was associated with changes in in-hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in-hospital cardiology services may need re-evaluation following SSU opening at a general hospital.

COVID-19 management in the emergency ward

The confirmed and suspected cases of the 2019 novel coronavirus disease (COVID-19) have increased in the entire world. There is still no vaccine or definitive treatment for this virus due to its unknown pathogenesis and proliferation pathways. Optimized supportive care remains the main therapy, and the clinical efficacy for the subsequent agents is still under investigation. Enormous demand for handling the COVID-19 outbreak challenged both the health-care personnel and medical supply system. As outbreaks of COVID-19 develop, prehospital workers, emergency medical services personnel, and other emergency responders are potentially asked to follow specific practice guidelines to mitigate the effects of an escalating pandemic. In this article, we have summarized the current guidance on potential COVID-19 management options. The recent experience with COVID-19 provided lessons on strategy and policymaking that the government and ministry of health should be on the alert and concentrate more on capacity to manage an outbreak like COVID-19. It is important to consider the new data that emerge daily regarding clinical characteristics, treatment options, and outcomes for COVID-19.

The dark side of SARS-CoV-2 rapid antigen testing: screening asymptomatic patients

Several reports showed SARS-CoV-2 rapid antigen tests (RATs) performances among COVID-19 symptomatic subjects in outpatient settings during periods of highest incidence of infections and high rates of hospital admissions, but few data are present for asymptomatic patients. We investigated the role of RATs in an emergency department, as a novel screening tool before admission for COVID-19 asymptomatic patients. A total of 116 patients were screened on admission in a 250-bed community hospital in Morges, Switzerland. RAT detected 2/7 RT-PCR-positive patients and delivered two false-positive results. These data suggest the non-fiability of RATs screening in this clinical scenario.

Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients' cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.

Psychiatric symptoms among patients with acute abdominal pain

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.

Assessment of Frequency and Causes of Medication Errors in Pediatrics and Emergency Wards of Teaching Hospitals Affiliated to Tehran University of Medical Sciences (24 Hospitals)

Introduction and Objective: Medical errors and adverse events are among the major causes of avoidable deaths and costs incurred on health systems all over the world. Medical errors are among the main challenges threatening the safety of patients in all countries and one of the most common types of medical errors is medication errors. This study aimed to determine the frequency, type, and causes of medication errors in the emergency and pediatric wards of hospitals affiliated to Tehran University of Medical Sciences in 2017. Materials and Methods: This study was a cross-sectional descriptive study which was conducted on 423 nurses working in teaching hospitals affiliated to Tehran University of Medical Sciences in 2017. The subjects were selected using the stratified sampling method. A total of 49 teaching hospitals in Tehran are affiliated to Tehran University of Medical Sciences and they are divided into two groups of general and specialized hospitals. Of all, 10 general hospitals and 14 specialized hospitals were randomly selected. The required data was collected using a three-part questionnaire. Using the SPSS software (version 18), the collected data was analyzed by means of ANOVA, Pearson Correlation Coefficient, and t-test and the results were reported as frequency, percentage, mean, and standard deviation. Results: According to the results of this study, the mean total number of medication errors that occurred within one month in the pediatric and emergency wards was roughly 41.9 cases, as stated by the nurses. The mean number of medication errors was higher in men than in women. Also, the two variables of gender and the type of shift work were related to medication errors; specifically, it was higher first in the evening and night shifts and then in the morning and evening shifts, respectively. Also, the number was higher in night shifts than in the morning shifts. The most common types of medication errors were: administration of the drugs at the wrong time, using a wrong technique of administration, wrong dosage, forgetting the dosage of the drug, administrating additional doses, administrating the drug to a wrong patient, and following the oral orders of physicians. On the other hand, the most common causes of medication errors in clinical wards were the following: illegible physician orders, shortage of manpower and high workload, incomplete physician orders, the use of lookalike and sound-alike drugs, absence of pharmacist/pharmaceutical expert in the ward, lack of dosage forms appropriate for children, and lack of adequate training regarding drug therapy. Discussion and Conclusion: Considering the results of this study, it is necessary to reduce the workload and working hours of nurses, increase medical staff's awareness of the significance of medication errors, revise the existing techniques of drug prescription, and update the indices of human resource in hospitals. It is also necessary to correct the process of naming and selecting the dosage forms of drugs by the industry.

Retrospective Evaluation of Patients Who Leave against Medical Advice in a Tertiary Teaching Care Institute

Context:

Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system.

Aims and Objectives:

The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases.

Subjects and Methods:

We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation.

Results:

A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%).

Conclusions:

About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.

The Effect of Aromatherapy with the Essential Oil of Orange on Pain and Vital Signs of Patients with Fractured Limbs Admitted to the Emergency Ward: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVE

Pain is an emotional and unpleasant experience associated with actual or potential tissue damage. The literature shows no study on the effect of aromatherapy with the essential oil of orange on unpleasant feelings of patients with fractured limbs. In this regard, this paper aims at studying the effect of aromatherapy with the essential oil of orange on patients with fractured limbs admitted to the emergency ward.

METHODS

Sixty patients admitted to the emergency ward of Vali-e-Asr Hospital were selected by purposive sampling method and then were divided into two groups of control and experiment by block method. This study was done in one shift work (morning or afternoon). Four drops of the orange oil were poured on a pad and were pinned with a plastic pin to the patient's collar, about 20 cm distant from head. The old pad was replaced by the new one every 1 h. The patients' pain and vital signs were checked every 1 h for at last 6 h. The data were analyzed by SPSS Version 21.

RESULTS

Forty (66.7%) patients were male and twenty (33.3%) were female. Their age average was 37.93 ± 18.19 years old. The most fractured cases were in the scapular (11 patients [18.3%]). Friedman test showed that pain in the experiment group (P = 0.0001) decreased significantly rather than the control group (0.339). However, in vital signs, there could be found that no significant change between the two groups was seen.

CONCLUSION

Aromatherapy with orange oil can relieve pain in patients with fractured limbs but has no effect on their vital signs. Therefore, aromatherapy with orange oil can be used as a complementary medicine in these patients.

Relationship between emotional intelligence and organizational citizenship behavior in critical and emergency nurses in south east of Iran

BACKGROUND

Several factors including emotional intelligence affect the efficiency of people. It seems that organizational behavior of each person is strongly influenced by emotional intelligence. Therefore, the present study is aimed to examine the relationship between emotional intelligence and organizational citizenship behavior in critical and emergency nurses in teaching hospitals supervised by Kerman Medical University in Southeast of Iran.

METHODS

This study employed a descriptive cross sectional design. A census sample consisted of 150 critical and emergency nurses working in teaching hospitals supervised by Kerman Medical University participated in this study. Emotional intelligence and organizational citizenship behavior questionnaire was used to assess nurses' emotional intelligence and organizational citizenship behavior by available sampling method.

RESULTS

The results showed that the mean age of the participants was 35 years. Most participants (94%) were females and belonged to the age group of 26-30 years. Overall mean score of organizational citizenship behavior scale was 88.21 (±10.4). In the organizational citizenship behavior categories, altruism mean score was higher than the other mean scores. Overall mean score of emotional intelligence was (121.08 ± 17.56). In the subgroups of emotional intelligence, mean score of the relationship management, was higher than the average of other factors. Pearson's correlation coefficient showed no significant relationship between emotional intelligence and organizational citizenship behavior (p ≥ 0.05).

CONCLUSIONS

The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with emotional intelligence and organizational citizenship behavior to assist critical and emergency nurses.