Emergency medicine in differently resourced settings: what can we offer each other? (original) (raw)
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The time it takes…' How doctors spend their time admitting a patient during the acute medical take
Clinical medicine (London, England), 2016
Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. History taking and examination by a core medical trainee took 22 minutes for a patient referred from the ED and 21 minutes for a patient referred from primary care. A complete admission clerking with prescription and ordering of investigations ranged from a mean of 15 minutes for a consultant in acute medicine to a mean of 55 minutes for a foundation year 1 trainee. The duration of post-take ward rounds also showed significant variability.Our data can be used to model staffing patterns if combined with information about admission numbers and local set up.
Caring for patients in emergency places
I have included these papers because they show the evolution of my thinking since the beginning of my masters work. My interested in EOL care hasn't changed, my interest in the theory of dialogic communication remains the same what has changed is my thesis methodological approach due to time and energy. Orginally I was going to undertake a narrative inquiry into EOL care in the emergency involving indepth interviews with 5 emergency nurses, now I am doing a qualitative research sysnthesis of EOL care in the emergency. I have included theses papers to provide encouragement for other masters students who, due to a number of circumstances, find they are facing changes in their methodological approach. A change in methodology does not represent a crisis but rather an oppertunity to learn other methods for exploring a topic of interest.
BMC Family Practice, 2010
Background: Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socioeconomical determinants for choosing the general practitioner (GP) on call or the ED. Methods: Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services.
Objectives: To describe the patient demographic characteristics and organisational factors (hat influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. Design: Prospective observational study. Setting: General medicine department of a teaching hospital in Belfast, UK. Partidpanb: Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. Outcome measures: Non-laboratory investigations requested, LOS and diagnosis on discharge. Results: Of B30 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p=0.0011) and for patients managed on non-medical wards (p<0.0001 ). There was a positive correlation between patient age and LOS (ro0.32, p<0.0001 ). Chest radiographs (p=0.006) and echocardiography (p<0.005) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, But no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. Condusion: A systematic means of dealing with the NHS resource crisis should indude an improved organisational strategy as well as social care provision. A mora unified approach to investigation practice should also have a sparing effect on resources.
Evaluation of Consultations Requested from Patients Admitted to the Emergency Department
Journal of Academic Emergency Medicine, 2015
Aim: This study was aimed to conduct an investigation towards evaluation of the efficiency of the consultation system that is in place in the emergency service of our hospital and identification and correction of deficiencies in this system. Materials and Methods: Patients who were admitted to the emergency department and for whom requesting a consultation were required for any reason were included in the study. Forms were filled out by the emergency research assistants. Patients whose data was incomplete and consents could not be obtained were excluded from the study. Results: A total of 213 patients were included in the study, and a total of 315 consultations were requested. The total number of consultations requested by the internal medicine departments was 126, and the total number of consultations requested by the trauma (surgery) departments was 189. Of the 213 patients, 104 (48.8%) were hospitalized and 109 (51.2%) were discharged. The average number of consultations of 213 patients was 1.5±0.7, the average length of stay of the patients in the emergency service was 366.7±312.9 min. and the mean age of the patients was 41±24 years. The average seniority of the consultant physicians in a total of 315 consultations performed was 26.8±10.6 months, and the average consultation response time of the consultant physicians was 62.2±67.8 min. Conclusion: Because of the changing healthcare system in our country, the consultation services, particularly in university hospitals, should be restructured .
Analysis of Consultations that are Requested from the Emergency Department
Cam and Sakura Medical Journal, 2021
In various studies conducted in different countries, the rate of requesting consultation in emergency services was reported to be between 20 and 56.4%. It was determined that the departments where the patients were hospitalized the most were general surgery (13.8%), neurology (13.4%), orthopedics and traumatology (12.0%), anesthesia (intensive care unit) (11.8%) and pediatric surgery (7.8%).
Perspectives of Emergency Department Staff on Triage Practice
Meandros Medical and Dental Journal, 2017
Objective: The aim of this study was to evaluate pre-training perspectives of the staff, who were scheduled to undertake triage in hospitals of Ministry of Health, working in collaboration with university hospitals on the triage system. Materials and Methods: This study included 33 workers who volunteered to participate. A questionnaire consisting of 19 questions on demographic characteristics and perspective on triage system was prepared. Results: Of the sample group, 75.8% were female and the average age was 28.94±6.11 years. All participants in the study considered that emergency department was overused by the society. When the percentage of patients who were admitted to the emergency department for causes complying with the emergency criteria was questioned, 54.5% stated that 10% or less of the admissions were actual emergency cases. Triage practice was suggested by 54.5% of the participants to reduce crowding in emergency departments. Conclusion: Triage practice which allows correct identification of patients who need the most urgent intervention in emergency departments is important in terms of both giving the right care to the right patients and quality of service provided by healthcare workers. Community-based education as well as training of workers on this subject is a necessity. Amaç: Üniversite hastaneleriyle ortak hizmet veren Sağlık Bakanlığı Hastaneleri'nde triaj hizmeti vermesi planlanan personelin eğitim öncesinde bu uygulamaya bakış açısının değerlendirilmesidir. Gereç ve Yöntemler: Bu çalışmaya gönüllü 33 çalışan dahil edildi. Anket formu sosyo-demografik bilgiler, acil sağlık hizmetleri ve triaja ilişkin konularda görüş isteyen 19 sorudan oluşan yargısal anket ölçeğiyle hazırlanmıştır. Bulgular: Örneklem grubunun %75,8'i kadın ve yaş ortalaması 28,94±6,11 idi. Çalışmaya dahil olan tüm katılımcılar acil servisin toplum tarafından gereksiz kullanıldığını belirtti. Acil servise herhangi bir nedenle başvuran hastaların ne kadarının acil kriterlerine uygun olduğu sorgulandığında ise %54,5 katılımcı bu oranın %10 ve daha az olduğunu bildirildi. Grubun %54,5'i, triaj uygulamasının acil servis kalabalığını azaltacağını düşünmekteydi. Sonuç: Triajın acil serviste uygulanması hem öncelikli hastaların bakımı hem de sağlık çalışanlarının sunduğu hizmetin kalitesini açısından önemlidir. Bu konuda çalışanların eğitimi kadar toplumsal bazlı bilgilendirmenin de yapılması gerekmektedir.
Emergency clinician output in a district hospital emergency centre: a cross-sectional analysis
African Journal of Emergency Medicine
By submitting this dissertation electronically, I, Mary Elizabeth Hoffe declare that the entirety of the work contained therein is my own, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification.