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Miazgowski B, Pakulski C, Miazgowski T. Length of Stay in Emergency Department by ICD-10 Specific and Non-Specific Diagnoses: A Single-Centre Retrospective Study. J Clin Med 2023; 12:4679. [PMID: 37510793 PMCID: PMC10380588 DOI: 10.3390/jcm12144679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The definition of non-specific presentation at a hospital emergency department (ED) has not yet been formally established. The purpose of this study was to assess the relationships between primary ED diagnoses identified by ICD-10 codes and ED length of stay (LOS). Over the course of three years, we examined 134,675 visits at a tertiary hospital. LOS was examined in groups with specific (internal, surgical, neurological, and traumatic diseases) and non-specific diagnoses. Our secondary objective was to measure LOS by age, day of the week, time of day, and season. The median LOS was 182 min (interquartile range: 99-264 min). LOS was 99 min in the traumatic group, while it was 132 min in the surgical group, 141 min in the non-specific group, 228 min in the internal medicine group, and 237 min in the neurological group. Other determinants of LOS were age, revisits, day of the week, and time of arrival-but not a season of the year. In the non-specific group (21% of all diagnoses), the percentage of hospitalizations was higher than in the specific groups. Our results suggest that in clinical practice, the non-specific group should be redefined to also encompass diagnoses from ICD-10 Chapter XXI (block Z00-Z99).
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Affiliation(s)
- Bartosz Miazgowski
- Doctoral School, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Cezary Pakulski
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Propaedeutic of Internal Diseases and Arterial Hypertension, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
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Arabani Nezhad M, Ayatollahi H, Heidari Beigvand H. Development and evaluation of an e-learning course in oxygen therapy. BMC MEDICAL EDUCATION 2022; 22:776. [PMID: 36357893 PMCID: PMC9648866 DOI: 10.1186/s12909-022-03838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Respiratory problems are among the most challenging situations in emergency care services. Different oxygen therapy methods are usually used to deal with these problems. In recent years, oxygen therapy has been recognized as one of the most widely used therapeutic processes in emergency departments (ED) mainly due to the Covid-19 pandemic. The aim of this study was to develop and evaluate an e-learning course in oxygen therapy for the ED clinicians. METHODS This was a pre-post study conducted in three phases in 2021. Initially, the educational requirements of clinicians (n = 181) were investigated using a questionnaire, and in the second phase, an interactive e-learning course was developed. In the third phase, the course was assessed in terms of maintaining the principles of developing an e-learning course, affecting participants' knowledge, and supporting usability requirements. RESULTS The findings revealed that training in oxygen therapy was essential for the ED clinicians. Therefore, an e-learning course was developed. The content production experts and the participants evaluated the content and usability of the online course at a good level. In addition, there was a statistically significant difference between the nurses' (p < 0.001) and general practitioners' (p < 0.002) pre- and post-test scores suggesting that the course improved their knowledge. CONCLUSION It seems that the e-learning course developed in the current study can improve health care professionals' knowledge and quality of care. However, more evaluation studies are needed to investigate the effectiveness of the course for other clinicians, such as nurses who work in intensive care units.
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Affiliation(s)
- Maryam Arabani Nezhad
- Present Address: Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hazhir Heidari Beigvand
- Family Medicine and Public Health Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Birrenbach T, Hoffmann M, Hautz SC, Kämmer JE, Exadaktylos AK, Sauter TC, Müller M, Hautz WE. Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study. BMC Emerg Med 2022; 22:109. [PMID: 35705901 PMCID: PMC9199121 DOI: 10.1186/s12873-022-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Misdiagnosis is a major public health problem, causing increased morbidity and mortality. In the busy setting of an emergency department (ED) patients are diagnosed under difficult circumstances. As a consequence, the ED diagnosis at hospital admittance may often be a descriptive diagnosis, such as “decreased general condition”. Our objective was to determine in how far patients with such an unspecific ED diagnosis differ from patients with a specific ED diagnosis and whether they experience a worse outcome. Methods We conducted a prospective observational study in Bern university hospital in Switzerland for all adult non-trauma patients admitted to any internal medicine ward from August 15th 2015 to December 7th 2015. Unspecific ED diagnoses were defined through the clinical classification software for ICD-10 by two outcome assessors. As outcome parameters, we assessed in-hospital mortality and length of hospital stay. Results Six hundred eighty six consecutive patients were included. Unspecific diagnoses were identified in 100 (14.6%) of all consultations. Patients receiving an unspecific diagnosis at ED discharge were significantly more often women (56.0% vs. 43.9%, p = 0.024), presented more often with a non-specific complaint (34% vs. 21%, p = 0.004), were less often demonstrating an abnormal heart rate (5.0% vs. 12.5%, p = 0.03), and less often on antibiotics (32.0% vs. 49.0%, p = 0.002). Apart from these, no studied drug intake, laboratory or clinical data including change in diagnosis was associated significantly with an unspecific diagnosis. Unspecific diagnoses were neither associated with in-hospital mortality in multivariable analysis (OR = 1.74, 95% CI: 0.60–5.04; p = 0.305) adjusted for relevant confounders nor with length of hospital stay (GMR = 0.87, 95% CI: 0.23–3.32; p = 0.840). Conclusions Women and patients with non-specific presenting complaints and no abnormal heart rate are at risk of receiving unspecific ED diagnoses that do not allow for targeted treatment, discharge and prognosis. This study did not find an effect of such diagnoses on length of hospital stay nor in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00665-x.
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Affiliation(s)
- Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland. .,Faculty of Medicine, Centre for Health Sciences Education, University of Oslo, Oslo, Norway.
| | - Michele Hoffmann
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Stefanie C Hautz
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
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Manji RA, Manji JS, Arora RC. Are maladaptive brain changes the reason for burnout and medical error? J Thorac Cardiovasc Surg 2021; 162:1136-1140. [DOI: 10.1016/j.jtcvs.2020.06.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/26/2022]
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Tudela P, Clotet S, Segura A, Carreres A. Patients whit non-specific complaints in the Emergency Department. Med Clin (Barc) 2021; 157:294-297. [PMID: 34229879 DOI: 10.1016/j.medcli.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Pere Tudela
- Unidad de observación y corta estancia, Servicio de Urgencias. Hospital Universitario Germans Trias i Pujol de Badalona. Universidad Autònoma de Barcelona.
| | - Sandra Clotet
- Unidad de observación y corta estancia, Servicio de Urgencias. Hospital Universitario Germans Trias i Pujol de Badalona. Universidad Autònoma de Barcelona
| | - Antònia Segura
- Unidad de observación y corta estancia, Servicio de Urgencias. Hospital Universitario Germans Trias i Pujol de Badalona. Universidad Autònoma de Barcelona
| | - Anna Carreres
- Unidad de observación y corta estancia, Servicio de Urgencias. Hospital Universitario Germans Trias i Pujol de Badalona. Universidad Autònoma de Barcelona
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Commentary: Are serious adverse events inevitable? J Thorac Cardiovasc Surg 2020; 162:1779-1780. [PMID: 32305189 DOI: 10.1016/j.jtcvs.2020.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/22/2022]
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Tudela P, Forcada C, Carreres A, Ballester M. Mejorar en seguridad diagnóstica: la asignatura pendiente. Med Clin (Barc) 2019; 153:332-335. [DOI: 10.1016/j.medcli.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/23/2019] [Indexed: 11/30/2022]
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Manji RA, Grocott HP, Arora RC. Medical Error and "Psycho-Physiology". Semin Thorac Cardiovasc Surg 2019; 31:397-398. [PMID: 31100339 DOI: 10.1053/j.semtcvs.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rizwan A Manji
- Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; Department of Anesthesia, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Hilary P Grocott
- Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; Department of Anesthesia, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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Martin-Fumadó C, Morlans M, Torralba F, Arimany-Manso J. Medical errors communication. Ethical and medicolegal issues. Med Clin (Barc) 2019; 152:195-199. [PMID: 30297254 DOI: 10.1016/j.medcli.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Carles Martin-Fumadó
- Área de Praxis, Servicio de Responsabilidad Profesional, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Màrius Morlans
- Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España; Comitè Ètic d'Investigació Clínica (CEIC), Colegio de Médicos de Barcelona, Comitè de Bioètica de Catalunya, Barcelona, España
| | | | - Josep Arimany-Manso
- Área de Praxis, Servicio de Responsabilidad Profesional, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España
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Tudela P, Molinos S, Esquerrà A, Carreres A. Bacteriuria asintomática en urgencias. Una causa frecuente de error diagnóstico. Med Clin (Barc) 2019; 152:29-32. [DOI: 10.1016/j.medcli.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
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