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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: emergency department (Page 1 of 2)

Influence of the adequacy of data collection, during two years, in the management of community-acquired pneumonia in emergency departments


Objective. The aim of this study was to analyze whether structured data collection of patients with community-acquired pneumonia (CAP) in the Emergency Department (ED) improves compliance with clinical guidelines regarding inpatient and outpatient treatment and prescription of antibiotics at discharge.
Material and methods. We performed a quasi experimental, multicenter, pre/post-intervention study. The intervention consisted of basic training for the participating physicians and the incorporation of a data collection sheet in the clinical history chart, including the information necessary for adequate decision making regarding patient admission and treatment, in the case of discharge. We analyzed the adequacy of the final destination of patients classified as Fine I-II and antibiotic treatment in patients receiving outpatient treatment, with each participating physician including 8 consecutive patients (4 pre-intervention and 4 post-intervention).
Results. A total of 738 patients were included: 378 pre-intervention and 360 post-intervention. In the pre-intervention group, Fine V was more frequent and patients were older, had more ischemic heart disease, active neoplasms and fewer risk factors for atypical pneumonia. Of the patients with Fine I-II, 23.7% were inadequately admitted and 19.6% of those discharged received treatment not recommended by guidelines. No differences were observed in the target variables between the two groups.
Conclusion. The adequacy of the decision to admit patients with Fine I-II CAP and outpatient antibiotic treatment can be improved in the ED. Structured data collection does not improve patient outcome.

Key words: community-acquired pneumonia, emergency department, antibiotic treatment, adequacy of admission

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Ed overcrowding – matematic models for integrated solutions and decisions

Dear Editor In Chief,

We are writing to You in line with an very interesting point of view regarding the Emergency Department (ED) development. The paper titled Improving  Emergency  Department Capacity Efficiency, published in your Journal 2016; 12(1): 52-57, as an original articles, spotlight solution for ED crowding.

So we are proposing a mathematics models for reciprocal accommodation of patients flows to the response capacity of the ED.

ED overcrowding is not just a reality but a huge problem, not only on satisfaction of staff and patients, but also in terms of ED performance. It is already known that, prolonged stay in ED is associated with lower compliance of ACC rules for care of ACS/NSTEMI (1) and increased mortality for hospitalized patients.(2,3)

Theoretically, there are two possible approaches: modulating demand (categorization and stratification of entries, triage, types and volume of auxiliary resources patients, use bifocal FastTrack for reducing time of wait) or enhancing capacity.

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Clinical application of lung ultrasound in emergency department patients for the evaluation of pulmonary congestion: a comparison with chest X-ray


Introduction. Lung ultrasound can effectively rule out pulmonary edema when there is an absence of multiple B-lines and enables emergency physicians to improve their diagnostic performance, optimize therapeutic strategy, help early diagnosis for the patient and reduced hospital stay. The primary endpoint of this pilot study was to evaluate the effectiveness of lung ultrasound for diagnosing acute heart failure, even when used by emergency medicine residents, and assess the accuracy of B-line lung ultrasound in comparison to chest X-ray in emergency department patients.

Materials and methods. We enrolled 18 patients consecutively as they arrived at the Emergency Department of Clinical Hospital „Sveti Duh“, Croatia, presenting with undifferentiated acute dyspnea. Positive ultrasound confirmation of acute heart failure was defined as the bilateral existence of 2 or more positive regions with 3 or more B-lines.

Results. We found positive results regarding B-lines profile in 6 patients and cardiac decompensation was confirmed by their chest x-ray findings. The remaining 12 patients did not have B-lines by the LUS examination, neither signs of pulmonary congestion by their chest x-ray examination.

Conclusion. Lung ultrasound, given its practicability, simplicity and reproducibility, used by non-experts in emergency ultrasound, is a reliable tool for clinical examination of patients with acute heart failure.

Key words: emergency department, ultrasonography, heart failure, extravascular lung water

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Improving Emergency Department Capacity Efficiency


Objective. The demand for emergency services has risen dramatically around the world. Many Emergency Departments (EDs) have signs of low capacity efficiency (which we define as the rate at which a production facility with limited resources can convert input into output); insufficient resources (staffing, equipment, facilities), inefficient ways to use them, or both. Our purpose was to investigate how to improve ED capacity efficiency through layout planning and present some novel ideas of ED bottlenecks.

Methods. We adopted an industrial engineering perspective to one Finnish ED as a case example. In contrary to a simple case report we used more generalizable methods and demand-supply chain analysis to improve capacity efficiency.

Results. This study resulted in concrete and generalizable improvements of capacity efficiency concerning both ED premises and staffing. The former includes designing patient locations, organizing beds, improving space usage and optimizing an ED layout. The latter identified the demand for different specialties and optimal allocation of nursing staff.

Conclusion. We present a rather unique combination of ways to enhance ED functionality by using methods of industrial engineering.

Key words: capacity efficiency, emergency department, operations management, healthcare

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Stray bullet injuries in a tertiary care center


Background. A stray bullet injury is defined as an accidental firearm injury occurring outdoors by an anonymous attacker. Stray bullet injuries are rare, but not uncommon in certain parts of the world. In Pakistan, 165 patients with stray bullet injuries were recorded between 2006 and 2010.

Objectives. In Lebanon, gunshots may occur during politicians’ speeches, funerals and after exam results are published. No studies to date have looked at the details and consequences of these gunshot injuries.

Methods. A retrospective chart review of patients presenting to an emergency department (ED) in Beirut, Lebanon, from 2010 to 2015, with clear stray bullet injuries was conducted. Variables included: demographics, injured body part, admission to hospital, number of days in hospital, length of stay in the ED, mortality, past medical history, emergency severity index, and consequences of injury including surgery.

Results. Out of 154 bullet injuries, 12 stray bullet injuries were recorded. Injuries of the lower extremity were most common, followed by the head, shoulder/thorax, abdomen/pelvis and upper extremity. Surgery was needed in 7 patients (58.3%). The median length of stay was 3.08 hours in the ED and 4.78 days in hospital. There were no recorded deaths. Consequences of each stray bullet injury are presented.

Conclusion. Stray bullet injuries are commonly reported on in news and media outlets. This is the first study in Lebanon and the region to document cases of stray bullet injuries presenting to the ED. Better laws and educational policies need to be implemented to help discourage this practice.

Key words: stray bullets, emergency department, injured body part, consequences of stray bullets, hospital admissions, severity of injury, surgical intervention, Lebanon

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