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Pan C, Pang JJ, Cheng K, Xu F, Chen YG. Trends and challenges of emergency and acute care in Chinese mainland: 2005-2017. World J Emerg Med 2021; 12:5-11. [PMID: 33505543 DOI: 10.5847/wjem.j.1920-8642.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emergency medical service system (EMSS) is essential in providing acute care services for health conditions. However, trends of emergency and acute care in China haven't been studied systematically. METHODS Relevant literature was carefully reviewed, including original and review articles, letters, government reports, yearbooks, both in Chinese and in English. Data on the number of emergency visits, physicians and beds in emergency departments (EDs), and the workforce of pre-hospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks (2006-2018). RESULTS Over the past decade, the number of ED visits tripled from 51.9 million to 166.5 million; and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 million. In response to rapid increases in demand, the number of licensed emergency physicians raised from 20,058 to 59,409; the beds' number increased from 10,783 to 42,367. For pre-hospital emergency care, the volume of health workforce increased from 3,687 to 8,671, with a 109% increase in the number of physicians from 1,774 to 3,712. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion were still the critical challenges faced by China's EMSS. CONCLUSIONS The number of emergency visits has grown with continual capability enhancement during the past decade. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion still need to be solved by China's EMSS. These findings and comparison with the USA could offer experiences and lessons to EMSS development worldwide, especially for developing countries.
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Affiliation(s)
- Chang Pan
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province; Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province; Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine; Qilu Hospital of Shandong University, Jinan 250012, China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine; Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jiao-Jiao Pang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province; Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province; Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine; Qilu Hospital of Shandong University, Jinan 250012, China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine; Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Cheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province; Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province; Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine; Qilu Hospital of Shandong University, Jinan 250012, China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine; Qilu Hospital of Shandong University, Jinan 250012, China
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province; Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province; Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine; Qilu Hospital of Shandong University, Jinan 250012, China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine; Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yu-Guo Chen
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province; Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province; Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine; Qilu Hospital of Shandong University, Jinan 250012, China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; the State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine; Qilu Hospital of Shandong University, Jinan 250012, China
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Jiang J, Tian NL, Cui HB, Li CL, Liu XB, Dong L, Sun Y, Chen XM, Chen SL, Xu B, Wang JA. Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography. World J Emerg Med 2020; 11:87-92. [PMID: 32076473 DOI: 10.5847/wjem.j.1920-8642.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI. METHODS The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI. RESULTS There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs. 22.0±9.7, P>0.05); and at 7-month follow-up (0.7% vs. 1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE). CONCLUSION In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety (ClinicalTrials.gov identifier: NCT02121223).
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Affiliation(s)
- Jun Jiang
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Han-Bin Cui
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Chang-Ling Li
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xian-Bao Liu
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Dong
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Sun
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Min Chen
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Jian-An Wang
- Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Chen SX, Fan K, Leung LP. Epidemiological characteristics and disease spectrum of emergency patients in two cities in China: Hong Kong and Shenzhen. World J Emerg Med 2020; 11:48-53. [PMID: 31893003 DOI: 10.5847/wjem.j.1920-8642.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shao-Xi Chen
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Karren Fan
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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Amaniyan S, Faldaas BO, Logan PA, Vaismoradi M. Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review. J Emerg Med 2019; 58:234-244. [PMID: 31843322 DOI: 10.1016/j.jemermed.2019.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Accepted: 11/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice. OBJECTIVE Our aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice. DISCUSSION Patient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care. CONCLUSIONS This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.
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Affiliation(s)
- Sara Amaniyan
- Student Research Committe, Semnan University of Medical Sciences, Semnan, Iran
| | - Bjørn Ove Faldaas
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst Campus, New South Wales, Australia
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