1
|
Ahmed FR, Timmins F. Prioritizing Well-Being: Fostering a Healthy Work Environment for Emergency Nurses. J Emerg Nurs 2024; 50:582-585. [PMID: 39174188 DOI: 10.1016/j.jen.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
|
2
|
Gill J, Greenhalgh S, Latour JM, Pickup S, Yeowell G. A novel approach to expedite emergency investigation for suspected cauda equina syndrome referrals from community and primary care services: A service evaluation. Musculoskelet Sci Pract 2024; 72:102976. [PMID: 38768530 DOI: 10.1016/j.msksp.2024.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Although a rare spinal emergency, cauda equina syndrome (CES) can result in significant physical, emotional, and psychological sequalae. Introducing a CES pathway enhances diagnosis but may increase Radiology and Orthopaedic workload. To address this, one NHS hospital in England introduced a novel CES pathway. Utilising a criteria-led pathway, patients were referred directly from community/primary care, via the Emergency Department, for an emergency MRI scan. OBJECTIVE To compare the outcomes of patients referred via an original and redesigned Community and Primary Care CES pathway. DESIGN A retrospective service evaluation was undertaken of all emergency MRI scans investigating suspected CES via either pathway. METHODS Two 3-month time periods were analysed; pre-(original) and post-implementation of the redesigned pathway; time to surgery was reviewed over two 12-month periods. RESULTS Increased MRI scan utilisation was seen following the implementation of the redesigned pathway: original n = 50, redesigned n = 128, increasing Radiology workload. However, the redesigned pathway resulted in a reduction in time to MRI from 3h:01m to 1h:02m; reduction in time spent in ED 4h:55m to 3h:24m; reduction in time to surgery 18h:05m to 13h:38m; reduction in out-of-hour scanning from 10 to 2 patients during the evaluation period; and a reduction in on-call Orthopaedic involvement by 38%. CONCLUSION All timed outcomes were improved with the implementation of this novel pathway. This suggests expediting MRI scans can result in substantial downstream benefits; albeit while increasing MRI scan utilisation. This pathway aligns with the emergency management of suspected CES under the new national CES pathway in England.
Collapse
Affiliation(s)
- Jonathon Gill
- Spinal Surgery Service, Somerset NHS Foundation Trust, Taunton, United Kingdom.
| | - Sue Greenhalgh
- Orthopaedic Interface Service, Bolton NHS Foundation Trust, Bolton, United Kingdom; Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jos M Latour
- School of Nursing, Faculty of Health, University of Plymouth, Plymouth, United Kingdom; South West Clinical School, Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Stephen Pickup
- Spinal Surgery Service, Somerset NHS Foundation Trust, Taunton, United Kingdom; Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gillian Yeowell
- Department of Health Professions, Faculty Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| |
Collapse
|
3
|
Möckel M, Catherine Janssens KA, Pudasaini S, Garcia-Castrillo Riesgo L, Moya Torrecilla F, Golea A, Reed MJ, Karamercan M, Fernández Cejas JA, Laribi S. The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group. Eur J Emerg Med 2024; 31:250-259. [PMID: 38874507 PMCID: PMC11198953 DOI: 10.1097/mej.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/26/2024] [Indexed: 06/15/2024]
Abstract
The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED. A variety of European diagnostic and therapeutic standards for syncope patients were reviewed and summarized in three rounds of a modified Delphi process by the European Society for Emergency Medicine syncope group. Based on a consensus statement, a detailed process pathway is created. The primary outcome of this work is the presentation of a universal process pathway for the structured management of syncope patients in European EDs. The here presented extended event process chain (eEPC) summarizes and homogenizes the process management of European ED syncope patients. Additionally, an exemplary translation of the eEPC into a practice-based flowchart algorithm, which can be used as an example for practical use in the ED, is provided in this work. Syncope patients, initially presenting with TLOC, are common and pose challenges in the ED. Despite variations in process management across Europe, the development of a universally applicable syncope eEPC in the ED was successfully achieved. Key features of the consensus and eEPC include ruling out life-threatening causes, distinguishing syncope from nonsyncopal TLOCs, employing syncope risk stratification categories and based on this, making informed decisions regarding admission or discharge.
Collapse
Affiliation(s)
- Martin Möckel
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Samipa Pudasaini
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Francisco Moya Torrecilla
- Vithas Xanit International Hospital and Clinical Lead, International Medical Services Vithas Xanit International Hospital Benalmadena, Malaga, Spain
| | - Adela Golea
- University of Medicine and Pharmacy Cluj, Emergency Unit - University Emergency County Hospital, Cluj Napoca, Romania
| | - Matthew J. Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Acute Care Edinburgh, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| |
Collapse
|
4
|
Berdida DJE, Alhudaib N. Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study. J Clin Nurs 2024. [PMID: 39072931 DOI: 10.1111/jocn.17393] [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: 02/11/2024] [Revised: 07/04/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
AIMS To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses. DESIGN Cross-sectional, correlational study. METHODS Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses. RESULTS The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care. CONCLUSION Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks. REPORTING METHOD STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
Collapse
Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, Manila, Philippines
- North Private College of Nursing, Arar City, Northern Borders Region, Saudi Arabia
| | - Noura Alhudaib
- North Private College of Nursing, Arar City, Northern Borders Region, Saudi Arabia
| |
Collapse
|
5
|
D’Silva R, Balakrishnan JM, Bari T, Verma R, Kamath R. Unveiling the Heartbeat of Healing: Exploring Organizational Culture in a Tertiary Hospital's Emergency Medicine Department and Its Influence on Employee Behavior and Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:912. [PMID: 39063488 PMCID: PMC11277175 DOI: 10.3390/ijerph21070912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
This study examined the organizational culture of an emergency medicine department (EMD) in a tertiary hospital in Karnataka, India, using a prospective cross-sectional design from January to February 2024. It aimed to identify the predominant and supporting organizational cultures within the EMD and their influence on employee behavior and well-being, including job satisfaction, burnout, stress levels, and coping strategies. A total of 82 participants, including physicians, emergency medical technicians, and nurses, completed the Organizational Culture Assessment Instrument (OCAI) and a self-designed questionnaire. Ethical clearance was obtained (IEC2-656). Clan culture emerged as the dominant culture (73.17%), emphasizing collaboration and adaptability, correlated with lower stress levels and high job satisfaction (90.78%). Emotional exhaustion was the most common burnout symptom (53.66%). The coping strategies varied, with employees in Clan cultures seeking social support, while those in Hierarchy cultures sought guidance from superiors. This study highlighted the significant role of organization culture in employee well-being and EMD effectiveness, influenced by social values like respect for authority. The limitations included single-setting analysis, an uneven subgroup representation, and a lack of qualitative insights. Future research should involve multiple hospitals and qualitative methods for a comprehensive understanding.
Collapse
Affiliation(s)
- Roshni D’Silva
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Jayaraj Mymbilly Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Tarushree Bari
- Directorate of Online Education, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Reena Verma
- Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Rajesh Kamath
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| |
Collapse
|
6
|
Holis RV, Elenjord R, Lehnbom EC, Andersen S, Fagerli M, Johnsgård T, Zahl-Holmstad B, Svendsen K, Waaseth M, Skjold F, Garcia BH. How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?-A Time and Motion Study. PHARMACY 2024; 12:106. [PMID: 39051390 PMCID: PMC11270314 DOI: 10.3390/pharmacy12040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Emergency departments (EDs) handle urgent medical needs for a diverse population. Medication errors and adverse drug events pose safety risks in the ED. Clinical pharmacists, experts in medication use, play a crucial role in identifying and optimizing medication therapy. The aim of this study was to investigate how clinical pharmacists introduced into the ED interdisciplinary teams distribute their work time. In a time and motion study, we used the Work Observation Method By Activity Timing (WOMBAT) to observe pharmacists in two Norwegian EDs. The pragmatic approach allowed pharmacists to adapt to ED personnel and patient needs. The pharmacists spent 41.8% of their work time on medication-related tasks, especially those linked to medication reconciliation, including documenting medication-related issues (16.2%), reading and retrieving written information (9.6%), and obtaining oral information about medication use from patients (9.5%). The remaining time was spent on non-medication-related tasks (41.8%), and on standby and movement (17.4%). In conclusion, ED pharmacists spent 42% of their work time on medication-related tasks, predominantly medication reconciliation. Their relatively new role in the interdisciplinary team may have limited their broader clinical impact. Relative to other ED healthcare professionals, ED pharmacists' goal remains to ensure accurate patient medication lists and appropriate medication use.
Collapse
Affiliation(s)
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, 9291 Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | | | - Sigrid Andersen
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Marie Fagerli
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, 9291 Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, 9291 Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Marit Waaseth
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Frode Skjold
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| | - Beate Hennie Garcia
- Hospital Pharmacy of North Norway Trust, 9291 Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, 9037 Tromso, Norway (K.S.)
| |
Collapse
|
7
|
Cohen I, Beigel R, Guetta V, Segev A, Fefer P, Matetzky S, Mazin I, Berger M, Perlman S, Barbash IM, Ziv-Baran T. Cardiology department versus intensive care unit admission after successful uncomplicated transcatheter aortic valve replacement (TAVR). Am J Med Sci 2024:S0002-9629(24)01274-6. [PMID: 38876433 DOI: 10.1016/j.amjms.2024.06.003] [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: 08/31/2023] [Revised: 05/11/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Most patients after transcatheter aortic valve replacement (TAVR) are admitted directly to the cardiac intensive care unit (CICU) despite low complication rates. Reducing unnecessary CICU hospitalization reduces healthcare costs. This study aimed to compare the outcomes between patients admitted directly to the cardiology department (CD) and those admitted to CICU based on prespecified protocols. METHODS Historical cohort study of all patients who underwent TAVR and were admitted directly to the CD according to a prespecified protocol (uncomplicated procedure, hemodynamically stable, without new conduction abnormalities) in 2017-2018, and the same number of patients meeting the same criteria who were admitted to the CICU in 2015-2016 before direct CD admission was initiated. Pacemaker implantation during the procedure was not considered a new conduction abnormality. In-hospital outcomes and 30-day post-discharge outcomes were compared. RESULTS Overall, 260 patients (130 CICU + 130 CD) were included in the study. There was no in-hospital mortality in either group, and the post-procedure length of stay was shorter for patients admitted to CD (median and IQR: 2, 2-4 vs. 4, 3-5 days, p <0.001). There was no significant difference in 30-day emergency department visits between groups (CICU:13.9% vs. CD:16.2%, p = 0.602), rehospitalization rate (9.3%) was the same in both groups, and one patient from the CICU group died. Similar results were observed in multivariable analysis and after matching. CONCLUSION Direct admission to the CD after TAVR, according to the proposed criteria, may be considered as a safe and less expensive alternative for stable patients after an uncomplicated TAVR procedure.
Collapse
Affiliation(s)
- Ilanit Cohen
- School of Public Health, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Matetzky
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Israel Mazin
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michael Berger
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Saritte Perlman
- School of Public Health, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Israel Moshe Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
8
|
Guerrero JG, Alqarni AS, Cordero RP, Aljarrah I, Almahaid MA. Perceived Causes and Effects of Overcrowding Among Nurses in the Emergency Departments of Tertiary Hospitals: A Multicenter Study. Risk Manag Healthc Policy 2024; 17:973-982. [PMID: 38660020 PMCID: PMC11041959 DOI: 10.2147/rmhp.s454925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose Emergency department (ED) overcrowding is a significant concern in many hospitals in Saudi Arabia, resulting in long waiting times, delays in treating patients who need urgent care, and, consequently, decreased patient satisfaction. Additionally, ED overcrowding has been linked to increased nurse turnover rates. Therefore, this study aimed to assess nurses' perceived causes and effects of overcrowding in the EDs of five tertiary hospitals in Saudi Arabia. Methods This study used a descriptive cross-sectional design. We surveyed 311 nurses working in the EDs of five tertiary hospitals in Saudi Arabia using the convenience sampling technique. The self-administered questionnaires used in the study were developed by the researchers. The study was conducted from October 16 to November 10, 2022. Consensus-Based Checklist for Reporting of Survey Studies was followed. Results The results revealed that the primary perceived causes of ED overcrowding in five tertiary hospitals were unnecessary visits due to a lack of standard procedures (mean = 2.70; SD = 0.58) and lack of inpatients beds (mean = 2.69; SD = 0.65). The perceived effect of overcrowding was stress and burnout among nurses (mean = 2.85; SD = 0.47). The perceived causes and effects of overcrowding in the ED were found to be highly significant (p <0.001) based on Pearson correlation and Spearman's rank correlation. Conclusion Unnecessary visits due to a lack of standard procedures lead to overcrowding. In addition, a lack of inpatient beds in the ED affects the care provided to patients seeking immediate medical attention. This may prolong patient waiting time, causing their conditions to deteriorate and prolonging hospital stay. Overcrowding leads to increased stress and burnout among nurses. The results of this study can be used to develop a comprehensive action plan to address ED overcrowding and its effects on patients, staff, and ED flow.
Collapse
Affiliation(s)
| | | | - Rock Parreno Cordero
- Emergency Health Services Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Imad Aljarrah
- Faculty of Nursing, Philadelphia University, Amman, Jordan
| | | |
Collapse
|
9
|
Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization. Ann Intensive Care 2024; 14:58. [PMID: 38625453 PMCID: PMC11019190 DOI: 10.1186/s13613-024-01282-6] [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: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.
Collapse
Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France.
- Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM - Paris Saclay University, Paris, France.
- EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France.
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique - Hôpitaux de Paris, and Paris Saclay University, Saclay, France.
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Guyane and Laboratoire Ecosystèmes Amazoniens et Pathologie Tropicale EA 3593, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, France
| | - Rémi Neviere
- Service des Explorations Fonctionnelles Centre Hospitalier Universitaire de Martinique et UR5_3 PC2E Pathologie Cardiaque, toxicité Environnementale et Envenimations (ex EA7525, Université des Antilles, Antilles, France
| | - Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, University of Montpellier, INSERM U1046, Centre Hospitalier Universitaire Montpellier, Montpellier, 34295, France
| | - Benoît Vivien
- Service d'Anesthésie Réanimation, SAMU de Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicholas Heming
- Department of Intensive Care, Raymond Poincaré Hospital, Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), APHP University Versailles Saint Quentin - University Paris Saclay, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, Garches, 92380, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, University of the Antilles, French West Indies, Antilles, France
| |
Collapse
|
10
|
Savioli G, Ceresa IF, Bavestrello Piccini G, Gri N, Nardone A, La Russa R, Saviano A, Piccioni A, Ricevuti G, Esposito C. Hypothermia: Beyond the Narrative Review-The Point of View of Emergency Physicians and Medico-Legal Considerations. J Pers Med 2023; 13:1690. [PMID: 38138917 PMCID: PMC10745126 DOI: 10.3390/jpm13121690] [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: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body-the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system-but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.
Collapse
Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Iride Francesca Ceresa
- Emergency Department and Internal Medicine, Istituti Clinici di Pavia e Vigevano, Gruppo San Donato, 27029 Vigevano, Italy;
| | | | - Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Alba Nardone
- Emergency Department, Ospedale Civile, 27058 Voghera, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.S.); (A.P.)
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.S.); (A.P.)
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, 27100 Pavia, Italy;
| | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| |
Collapse
|
11
|
Kabil G, Frost SA, Hatcher D, Shetty A, McNally S. Facilitators and barriers of appropriate and timely initiation of intravenous fluids in patients with sepsis in emergency departments: a consensus development Delphi study. BMC Nurs 2023; 22:402. [PMID: 37891553 PMCID: PMC10604401 DOI: 10.1186/s12912-023-01561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening medical emergency in which appropriate and timely administration of intravenous fluids to patients with features of hypotension is critical to prevent multi-organ failure and subsequent death. However, compliance with recommended fluid administration is reported to be poor. There is a lack of consensus among emergency clinicians on some of the determinant factors influencing fluid administration in sepsis. Thus, the aim of this study was to identify the level of consensus among key stakeholders in emergency departments regarding the facilitators, barriers, and strategies to improve fluid administration. METHODS The modified Delphi questionnaire with 23 statements exploring barriers, facilitators, and strategies to improve fluid administration was developed from the integration of findings from previous phases of the study involving emergency department clinicians. A two-round modified Delphi survey was conducted among key stakeholders with managerial, educational, supervision and leadership responsibilities using a "Reactive Delphi technique" from March 2023 to June 2023. The statements were rated for importance on a 9-point Likert scale. The RAND/UCLA Appropriateness Method (RAM) was used to identify the level of consensus (agreement/disagreement). RESULTS Of the 21 panellists who completed Round 1 survey, 18 (86%) also completed Round 2. The panellists rated 9 out of 10 (90%) barriers, 3 out of 4 (75%) facilitators and all 9 (100%) improvement strategies as important. Out of the total 23 statements, 18 (78%) had agreement among the panellists. Incomplete vital signs at triage (Median = 9, IQR 7.25 to 9.00) as a barrier, awareness of importance of fluid administration in sepsis (Median = 9, IQR 8.00 to 9.00) as facilitator and provision of nurse-initiated intravenous fluids (Median = 9, IQR 8.00 to 9.00) as an improvement strategy were the highest rated statements. CONCLUSION This is the first Delphi study identifying consensus on facilitators, barriers, and strategies to specifically improve intravenous fluid administration in sepsis in Australia. We identified 18 consensus-based factors associated with appropriate and timely administration of intravenous fluids in sepsis. This study offers empirical evidence to support the implementation of the identified strategies to improve patient outcomes.
Collapse
Affiliation(s)
- Gladis Kabil
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia.
- Department of Emergency, Westmead Hospital, Sydney, Australia.
| | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, Australia
- University of New South Wales, Sydney, Australia
- School of Nursing and Midwifery, University of Wollongong, Wollongong, Australia
| | - Deborah Hatcher
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia
| | - Amith Shetty
- Westmead Institute for Medical Research, Sydney, Australia
- NSW Ministry of Health, Sydney, Australia
| | - Stephen McNally
- Western Sydney University, School of Nursing and Midwifery, Sydney, Australia
| |
Collapse
|
12
|
Ataman MG, Sariyer G, Saglam C, Karagoz A, Unluer EE. Factors Relating to Decision Delay in the Emergency Department: Effects of Diagnostic Tests and Consultations. Open Access Emerg Med 2023; 15:119-131. [PMID: 37143526 PMCID: PMC10153439 DOI: 10.2147/oaem.s384774] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The purpose of this study is to investigate the factors increasing waiting time (WT) and length of stay (LOS) in patients, which may cause delays in decision-making in the emergency departments (ED). Patients and Methods Patients who arrived at a training hospital in the central region of Izmir City, Turkey, during the first quarter of 2020 were retrospectively analyzed. WT and LOS were the outcome variables of the study, and gender, age, arrival type, triage level determined based on the clinical acuity, diagnosis encoded based on International Classification of Diseases-10 (ICD-10), the existence of diagnostic tests or consultation status were the identified factors. The significance of the differences in WT and LOS values based on each level of these factors was analyzed using independent sample t-tests and ANOVA. Results While patients for which no diagnostic testing or consultation was requested had a significantly higher WT in EDs, their LOS values were substantially lower than those for which at least one diagnostic test or consultation was ordered (p≤0.001). Besides, elderly and red zone patients and those who arrived by ambulance had significantly lower WT and higher LOS values than other levels for all groups of patients for which laboratory-type or imaging-type diagnostic test or consultation was requested (p≤0.001 for each comparison). Conclusion Besides ordering diagnostic tests or consultation in EDs, different factors may extend patients' WT and LOS values and cause significant decision-making delays. Understanding the patient characteristics associated with longer waiting times and LOS values and, thus, delayed decisions will enable practitioners to improve operations management in EDs.
Collapse
Affiliation(s)
- Mustafa Gokalp Ataman
- Department of Emergency Medicine, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
- Correspondence: Mustafa Gokalp Ataman, Department of Emergency Medicine, Bakırçay University Çiğli Training and Research Hospital, 8780/1 Street No: 18 Yeni Mahalle Ata Sanayi / Çiğli, İzmir, Turkey, Tel +90 232 398 37 00, Fax +90 444 35 30, Email
| | - Gorkem Sariyer
- Department of Business Administration, Yaşar University, İzmir, Turkey
| | - Caner Saglam
- Department of Emergency Medicine, University of Health Sciences Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Arif Karagoz
- Department of Emergency Medicine, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
| | - Erden Erol Unluer
- Department of Emergency Medicine, University of Health Sciences Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|