Structure and function of the emergency department: matching emergency department choices to the emergency department mission

Situation analysis model of hospital emergency department promotion in Iran: A cross-sectional study

Background and Aim

The present study was conducted to develop a situation analysis model for Iran's hospitals' emergency departments (EDs).

Methods

The current research was a descriptive cross-sectional applied study in three stages. The studies were reviewed in various library resources and valid sites in the first stage. In the second stage, the analysis model of the ED in Iran was presented. In the third stage, the model was validated based on the Delphi technique, and the final model was presented.

Results

The final situation analysis model of ED in Iran was approved in four main aspects, including goals, internal factors, external factors, and organizations and institutions participating in the situation analysis, and its implementation schedule was approved by 90% of experts.

Conclusion

Considering the importance of situation analysis in developing a strategic plan and improving the quality of health services in the ED of hospitals, implementing a coherent situation analysis model that includes all aspects leading to improving the ED quality and analyzing the internal and external factors is vital.

The Burden of Alcohol-Related Emergency Department Visits in a Hospital of a Large European City

(1) Alcohol consumption contributes to the development of numerous diseases and is a big organizational burden on emergency departments (EDs). (2) We examined data on alcohol-related ED admissions in Poznan, Poland between 1 April 2019 and 31 March 2022. A total of 2290 patients' records were collected and analysed. The main goal was to determine the impact that these visits had on the functioning of the ED and the hospital. (3) The alcohol-related admission rate was significantly higher in males (78.95% vs. 21.05%), and the median blood alcohol concentration (BAC) level was 2.60 (1.78-3.38) ‱. Most of the visits took place at weekends and in the evening. Patients with higher BAC tended to stay longer in the ED, but had a lower chance of being admitted. A majority of patients required radiology and laboratory testing, 20.44% needed psychiatric examination, and 19.69% suffered trauma, mainly to the head. (4) Injuries and mental problems were the most common medical emergencies. This study presents trends in alcohol-related ED attendances, examines reasons for visits, and makes an attempt to assess overall burden on EDs.

Post-resuscitation care at the emergency department with critical care facilities--a length-of-stay analysis

AIM OF THE STUDY

An emergency department providing critical care will have an effect on outcome and intensive-care-units' resources by avoiding unnecessary or futile intensive-care admissions and thereby save hospital expenses. The study focussed on this result.

METHODS

The study employed a retrospective analysis of prospectively collected data of out-of-hospital cardiac arrest patients with return of spontaneous circulation, comatose on arrival. Outcomes and length of stay of patients who either stayed at the 'emergency department only' or were 'transferred in addition to an intensive care unit' were compared. Linear regression with log length of stay as outcome and 'emergency department only' as predictor with covariates was used for modelling.

RESULTS

From 1991 to 2008, out of 1236 patients (age 57 ± 15 years, female 31%), the 'emergency department only' group (n=349 (28%)) survived to discharge in 81(23%) cases, with a median length-of-stay in critical care of 1.7 (interquartile range 0.8; 3.1) days. The patients 'transferred in addition to an intensive care unit' (n=887 (72%)), with a survival rate of 55% (n=486, p<0.001) stayed 10 (5; 18) days (p<0.001). The length-of-stay in hospital was significantly shorter if patients were treated in the 'emergency department only' independent of other cardiac-arrest-related factors (regression coefficient -1.42, confidence interval -1.60 to -1.24).

CONCLUSIONS

An emergency department with critical care prevents admissions to intensive care units in 28% of patients with out-of-hospital cardiac arrest. It saves intensive-care-unit resources and shortens length of stay for comatose out-of-hospital cardiac-arrest survivors, regardless of their outcome.