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Urbina A, Juvé-Udina ME, Romero-García M, Delgado-Hito P, González-Samartino M, Adamuz J. Care complexity factors associated with revisits to an emergency department. Emergencias 2023; 35:245-251. [PMID: 37439417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. MATERIAL AND METHODS Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. RESULTS A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFs was associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. CONCLUSION The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting.
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Affiliation(s)
- Andrea Urbina
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Departamento de Enfermería Fundamental y Médico- Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, España. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Maria-Eulàlia Juvé-Udina
- IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Instituto Catalán de la Salud, Barcelona, España
| | - Marta Romero-García
- Departamento de Enfermería Fundamental y Médico- Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, España. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Proyecto Internacional de Investigación para la Humanización de la Asistencia Sanitaria, Proyecto HU-CI
| | - Pilar Delgado-Hito
- Departamento de Enfermería Fundamental y Médico- Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, España. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Proyecto Internacional de Investigación para la Humanización de la Asistencia Sanitaria, Proyecto HU-CI
| | - Maribel González-Samartino
- Departamento de Enfermería Fundamental y Médico- Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, España. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Área de Calidad, Conocimiento y Metodología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Jordi Adamuz
- Departamento de Enfermería Fundamental y Médico- Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, España. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Área de Calidad, Conocimiento y Metodología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Valle Alonso J, Rivera-Caravaca JM, Fonseca FJ, Noblía L, Cruzado J, Nolasco Bonmati A. Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale. Emergencias 2021; 33:85-92. [PMID: 33750048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF). MATERIAL AND METHODS Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model. RESULTS We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67-81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III-IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869-0.928; P .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796-0.894; P .001). CONCLUSION The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF.
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Affiliation(s)
| | - José Miguel Rivera-Caravaca
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIBArrixaca), Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Murcia, España. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Reino Unido
| | | | - Leandro Noblía
- Servicio de Urgencias, Hospital Santa Lucia, Cartagena, España
| | - Jesús Cruzado
- Servicio de Urgencias, Hospital Santa Lucia, Cartagena, España
| | - Andreu Nolasco Bonmati
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, España
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Jacob J, Cabello I, Yuguero O, Alexis Guzmán J, Arranz Betegón M, Abadías MJ, Francés Artigas P, Santos J, Esquerrà A, Mòdol JM. Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days. Emergencias 2019; 31:99-106. [PMID: 30963737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. MATERIAL AND METHODS Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. RESULTS We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. CONCLUSION We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge.
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Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat Barcelona, España
| | - Irene Cabello
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat Barcelona, España
| | - Oriol Yuguero
- Servicio de Urgencias, Hospital Arnau de Vilanova, Lleida, España
| | - Jorge Alexis Guzmán
- Servicio de Urgencias, Hospital Universitari Joan XXIII de Tarragona, España
| | | | | | | | - Julia Santos
- Servicio de Urgencias, Hospital de Viladecans, Barcelona, España
| | - Anna Esquerrà
- Servicio de Urgencias, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, España
| | - Josep María Mòdol
- Servicio de Urgencias, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, España
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Carratalá JM, Díaz Lobato S, Brouzet B, Más-Serrano P, Espinosa B, Llorens P. Efficacy and safety of high-flow nasal cannula oxygen therapy in patients with acute heart failure. Emergencias 2019; 30:395-399. [PMID: 30638342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of high-flow nasal cannula (HFNC) oxygen therapy in patients in acute respiratory failure due to acute heart failure (AHF) refractory to conventional oxygen therapy or noninvasive ventilation. METHODS Prospective observational study of patients with AHF and respiratory failure attended in an emergency department whose condition worsened after they were admitted to a short-stay unit, leading to use of HFNCs. Efficacy was assessed using a modified Borg dyspnea scale and oxygenation variables on discharge from the emergency department. Data were recorded after 24 hours on conventional oxygen therapy and after 60 and 120 minutes and 24 hours of HFNC therapy. Safety outcomes were the degree of patient comfort and the frequency of adverse events. RESULTS Prospective observational study of patients with AHF and respiratory failure attended in an emergency department whose condition worsened after they were admitted to a short-stay unit, leading to use of HFNCs. Efficacy was assessed using a modified Borg dyspnea scale and oxygenation variables on discharge from the emergency department. Data were recorded after 24 hours on conventional oxygen therapy and after 60 and 120 minutes and 24 hours of HFNC therapy. Safety outcomes were the degree of patient comfort and the frequency of adverse events. CONCLUSION HFNC oxygen therapy offers a treatment alternative for patients with acute respiratory failure due to AHF.
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Affiliation(s)
- José Manuel Carratalá
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Alicante, España. Grupo Multidisciplinar Español para el Soporte Terapéutico con Terapia de Alto Flujo en Adultos (HISPAFLOW)
| | - Salvador Díaz Lobato
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España. Grupo Multidisciplinar Español para el Soporte Terapeútico con Terapia de Alto Flujo en Adultos (HISPAFLOW)
| | - Benjamin Brouzet
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Alicante, España
| | - Patricio Más-Serrano
- Servicio de Farmacia. Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Alicante, España. División de Farmacia y Tecnología Farmacéutica. Universidad Miguel Hernández. Elche, Alicante, España
| | - Begoña Espinosa
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Alicante, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Alicante, España
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Piñera Salmerón P, Delgado Romero J, Domínguez Ortega J, Labrador Horrillo M, Álvarez Gutiérrez FJ, Martínez Moragón E, Plaza Moral V, Álvarez Rodríguez C, Miguel Franco J. Management of asthma in the emergency department: a consensus statement. Emergencias 2019; 30:268-277. [PMID: 30033702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this consensus statement is to provide a tool to assist in the management of asthma in Spanish emergency departments and to improve care of patients with asthma. A multidisciplinary team of 3 emergency medicine specialists, 3 respiratory medicine specialists, and 3 allergy specialists made a list of clinical questions and chose 4 clinical practice guidelines on asthma management to prioritize when answering the questions. The team members first worked individually and then discussed their findings in a meeting to reach consensus about the content of the present statement. The recommendations and clinical algorithms in the statement contribute to detecting the asthmatic patient on arrival at the emergency department, establishing the diagnosis, following unified treatment criteria, and referring the patient to a respiratory medicine specialist, an allergy specialist, or a primary care physician, as appropriate. The definitions used in this statement provide a common language for asthma in the interest of helping to unify care practices in emergency departments. The diagnostic criteria, treatment guidelines, and criteria for discharging and admitting patients provided should be useful for managing asthma in Spanish emergency departments.
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Affiliation(s)
| | - Julio Delgado Romero
- Unidad de Gestión Clínica de Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Javier Domínguez Ortega
- Servicio de Alergia, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ). CIBER de Enfermedades Respiratorias (CIBERES). Madrid, España
| | | | | | | | - Vicente Plaza Moral
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Oltra Hostalet F, Núñez-Núñez M, Portillo Cano MDM, Navarro Bustos C, Rodríguez-Baño J, Retamar Gentil P. Analysis of quality antimicrobial agent use in the emergency department of a tertiary care hospital. Emergencias 2018; 30:297-302. [PMID: 30260113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe modifiable factors related to inappropriate antimicrobial treatment in the observation area of an emergency department to explore practices that can be targeted for change through a program to improve emergency use of antimicrobial agents, the PROA program in its spanish observations. MATERIAL AND METHODS Cross-sectional serial point-prevalence study of all antimicrobial prescriptions for patients under observation in the department in February and March 2015.The main outcome measure was the frequency of antimicrobial treatment that was inappropriate according the center's guidelines. Two evaluators assessed appropriateness. RESULTS We analyzed 406 antimicrobial treatments. The main clinical syndromes were pneumonia (24%), urinary infections (22%), and nonpneumonia lower respiratory infections (22%). We found that 51.5% of the antimicrobial treatments were inappropriate. Factors associated with inappropriate prescriptions were a failure to analyze microbiologic samples before treating (61%), failure to specify the focus of infection in the case records (73%), and failure to meet the definition of sepsis (58%). CONCLUSION Fewer than half the antimicrobial treatments were appropriate as prescribed. Signs of serious infection, specification of the focus of infection in the patient's records, and the analysis of biologic samples were independent predictors of quality care (appropriate antimicrobial prescription). These factors can be targeted for training in the development of a specific emergency department program to improve this aspect of care.
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Affiliation(s)
- Fernando Oltra Hostalet
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Virgen Macarena, Sevilla, España
| | - María Núñez-Núñez
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, España. Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva/Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen Macarena/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, España
| | | | - Carmen Navarro Bustos
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Jesús Rodríguez-Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva/Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen Macarena/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, España. Departamento de Medicina. Universidad de Sevilla, España
| | - Pilar Retamar Gentil
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva/Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen Macarena/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, España
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7
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Martínez Soba F, Masnou Burrallo N, de la Rosa Rodríguez G, Povar Marco J. [Emergency department staff and the organ donation process: recommendations from the joint working group of the National Transplant Organization and the Spanish Society of Emergency Medicine (ONT-SEMES)]. Emergencias 2016; 28:193-200. [PMID: 29105454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although 4769 transplants were performed in Spain in 2015 and the organ donor rate reached 39.7 per million population, thousands of patients remain on wait lists. Currently 65% of donors die from strokes and the mean donor age is 64 years. This profile calls for strategies to detect candidates outside the intensive care unit (ICU) and it justifies an ever stronger role for the participation of emergency services in the procurement process. Spain's National Transplant Organization (ONT) and the Spanish Society of Emergency Medicine (SEMES) have drafted recommendations whose purposes are to define the responsibilities of emergency staff in this process, to establish protocols for multidisciplinary cooperation that facilitate the identification of candidate donors, and to consolidate a new approach to patient care that will facilitate optimal management of the donor prior to ICU admission.
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Affiliation(s)
| | | | | | - Javier Povar Marco
- Coordinador de Urgencias del Hospital Universitario Miguel Servet de Zaragoza, España
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Fernández-Guerrero IM, Burbano Santos P, Martín-Sánchez FJ, Hidalgo-Rodríguez A, Leal-Lobato MDLM, Rivilla-Doce C, Julián-Jiménez A, Burillo-Putze G, Miró Ò. [Productivity of Spanish emergency physicians: comparison of the 5-year periods 2010-2014 and 2005-2009]. Emergencias 2016; 28:153-166. [PMID: 29105448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study the publication productivity of Spanish emergency physicians in the 5-year period from 2010 through 2014 and compare it with the previous period (2005-2009). MATERIAL AND METHODS Articles authored by emergency physicians affiliated with institutions in Spain were selected from the Science Citation Index-Expanded; conference presentations were excluded. We collected data for year of publication, author information, journal, the journal's impact factor (IF), type of article, cites received, and area of research. We searched at 2010-2014 period, and these data were compared with historic data from the 2005-2009 period. RESULTS A total of 1433 articles were published in 2010-2014; 52.4% were original research articles (56% more than in 2005-2009, P=.01). The mean journal IF associated with the publications was slightly higher in 2010-2014 (2.587 vs 2.483 for 2005-2009). The median was slightly lower (2.295 vs 3.085 in the earlier period), but the 90th percentile was higher (4.036 vs 3.085, P=0.01), reflecting an increase in the number of publications in journals with high IFs. Most articles continue to be published in Castilian Spanish (67.8%), although the percentage of articles published in English increased significantly, from 25.2% in the previous period to 32.1% in 2010-2014; P=.001). Scientific publications in emergency medicine come mainly from specialists working in hospital emergency departments (89%). Authors affiliated with a university are in the minority, although their percentage increased significantly from 10.9% in the previous period to 16.2% in the recent one (P=.001). Collaboration increased in the recent period in all categories: between hospitals in the same Spanish autonomous community (from 24.7% to 36%), in different communities (from 10.9% to 19%), or in different countries (from 2.3% to 8.4%) (P=.001, all comparisons). The most productive research areas were cardiovascular conditions (accounting for 13.1% of the publications), infectious diseases (13.0%), toxicology and pharmacology (9.2%), pediatric emergencies (8.0%), respiratory diseases (7.4%), cardiopulmonary resuscitation (6.7%), and management (6.0%). Catalonia produced the largest number of papers (427 [29.8%]). Hospital Clínic de Barcelona ranked first among hospitals publishing research, with 145 articles (11.4% of the total in this category); the emergency services of Madrid (SUMMA-112) ranked first among out-of-hospital research groups, with 43 publications (36.7% of the total in this category). Catalonia, Madrid, Castile-La Mancha, the Canary Islands, Murcia, the Balearic Islands, and La Rioja increased their contributions to Spanish productivity by 20% or more over their output in the earlier 5-year period. Nine of the 2010-2014 articles have already attracted enough cites to be considered citation classics. CONCLUSION The productivity of Spanish emergency physicians continued to grow at a good pace in the 2010-2014 period. Publications in journals with IFs increased and there were significant changes in the dynamics of publication and the subjects covered.
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Affiliation(s)
- Inés M Fernández-Guerrero
- Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España. Grupo de investigación "Urgencias: procesos y patologías" IDIBAPS, Barcelona, España
| | - Pablo Burbano Santos
- Grupo de investigación "Urgencias: procesos y patologías" IDIBAPS, Barcelona, España. Ministerio de Educación, Quito, Ecuador
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) de Madrid, Facultad de Medicina de la Universidad Complutense de Madrid, España
| | | | | | - Celia Rivilla-Doce
- Servicio de Urgencias, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | | | - Òscar Miró
- Grupo de investigación "Urgencias: procesos y patologías" IDIBAPS, Barcelona, España. Área de Urgencias, Hospital Clínic, Barcelona, España
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Gómez-Alonso B, Rodríguez-Álvarez C, Castro Hernández B, Arias Rodríguez Á, Aguirre-Jaime A, Lecuona Fernández M. [Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities]. Emergencias 2016; 28:381-386. [PMID: 29106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. MATERIAL AND METHODS A descriptive cross-sectional study was carried out in 2014 (April–June). LTCF residents in the northern part of the island of Tenerife were eligible for enrollment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsedfield gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrollment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29–3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11–2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSION LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals.
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Affiliation(s)
- Bárbara Gómez-Alonso
- Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, España
| | | | | | | | - Armando Aguirre-Jaime
- Unidad de Investigación, Hospital Universitario de Nuestra Señora de la Candelaria, España
| | - María Lecuona Fernández
- Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, España. Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, España
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Hernández Ruipérez T, Leal Costa C, Adánez Martínez MDG, García Pérez B, Nova López D, Díaz Agea JL. [Evidence of the validity of the Emergency Severity Index for triage in a general hospital emergency department]. Emergencias 2015; 27:301-306. [PMID: 29087054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine whether the Emergency Severity Index (ESI) is valid for triage according to evidence based on classifying real patients in a general referral hospital's emergency department. MATERIAL AND METHODS Observational, cross-sectional descriptive study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Thirty-two nurses used the ESI algorithm to triage 410 patients as they arrived seeking care. The results were compared to a gold standard (a triage expert's opinion, which was later confirmed by an expert committee after discussion, if necessary, of cases for which opinions were not unanimous). We calculated sensitivity, specificity, under- and over-triage rates, as well as descriptive statistics about resource assignment, exitus, patients who left without being seen, destination on discharge, and times. RESULTS ESI was highly correlated with resources (ρ = -0.717, P < .01) and moderately correlated with destination on discharge (ρ = -0.437, P < .01). Regarding time spent in the department, we found that patients assigned ESI levels 1 and 2 had significantly longer stays, and those assigned ESI levels 4 and 5 had significantly shorter stays (p < 0,001). Interobserver agreement was good or very good, indicating that this triage tool is reliable. CONCLUSION This pilot of the ESI triage algorithm in the emergency department of a referral hospital found evidence supporting the system's validity.
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Affiliation(s)
- Tomás Hernández Ruipérez
- Servicio de Urgencias. Hospital Clínico Universitario Virgen de la Arrixaca. Simulación Clínica. Murcia, España
| | - César Leal Costa
- Unidad Simulación Clínica. Facultad de Enfermería. Universidad Católica de Murcia (UCAM). Murcia, España
| | - María de Gracia Adánez Martínez
- Servicio de Urgencias. Hospital Clínico Universitario Virgen de la Arrixaca. Simulación Clínica. Facultad de Enfermería. Universidad Católica de Murcia (UCAM). Murcia, España
| | - Bartolomé García Pérez
- Unidad de Corta Estancia. Hospital Clínico Universitario Virgen de la Arrixaca. Facultad de Ciencias de la Salud. Universidad Católica de Murcia (UCAM). Murcia, España
| | - Daniel Nova López
- Servicio de Urgencias. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia, España
| | - José Luis Díaz Agea
- Facultad de Enfermería. Universidad Católica de Murcia (UCAM). Murcia, España
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Llorens P, Escoda R, Miró Ò, Herrero-Puente P, Martín-Sánchez FJ, Jacob J, Garrido JM, Pérez-Durá MJ, Gil C, Fuentes M, Alonso H, Muller C, Mebazaa A. [Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments)]. Emergencias 2015; 27:11-22. [PMID: 29077328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To analyze data recorded in the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments), which collects information on the clinical characteristics and laboratory findings of patients with acute heart failure (AHF) treated in 29 Spanish hospital emergency departments (EDs) as well as therapies used and clinical course. We analyzed changes in management observed over time and compared the results with data recorded in other AHF registries. MATERIAL AND METHODS Prospective multicenter cohort study of consecutive patients treated in 3 different years: 2007, 2009, and 2011. We collected demographic, clinical, and laboratory data; medications taken prior to the emergency and in the ED; and outcome variables (in-hospital and 30-day and 1-year mortality rates, readmissions within 30 days). Changes in therapy and course in the 3 years were analyzed. The literature was reviewed to find other national and international AHF registries. RESULTS A total of 5845 patients were included (2007, 948; 2009, 1483; 2011, 3414). The mean age was 79 years and 56% were women. The AHF episode registered was the first experienced by 34.6% of the patients. Comorbidity was high: 82% had hypertension, 42.3% had diabetes mellitus, and 47.7% had atrial fibrillation. Severe or total functional dependence was observed in 21.9%, and 57.3% had systolic dysfunction (left ventricular ejection fraction, 38.3%). The main treatments administered consisted in diuretics (96.8%), endovenous nitroglycerine (20.7%), noninvasive ventilation (6.4%), and inotropic agents or vasopressors (3.6%). The glomerular filtration rate was low in 57%. Troponin and natriuretic peptide levels were measured in the EDs in 49.1% and 42.4% of the cases, respectively. Patients presented as normotensive in 66.4% of the cases, hypertensive in 23.5%, and hypotensive in 4.6% (0.7% in shock); 76.1% were admitted (1.9% to the ICU). The median hospital stay was 7 days and 23.9% were discharged from the ED. In-hospital mortality was 7.6%; 30-day mortality was 9.4% and 1-year mortality 29.5%. Orders for troponin and natriuretic peptide determinations increased over the 3 study periods, and the intravenous infusion of diuretics and inotropic agents and vasoconstrictors decreased (P < 0.001, all comparisons). Revisits within 30 days also decreased (P = 0.004). No changes were observed in in-hospital or 30-day mortality rates between 2007 and 2011. We reviewed 14 previously published registry reports (8 compiled prospectively); only 2 of the registries included ED patients. CONCLUSION The EAHFE registry describes the characteristics of AHF in a cohort that resembles the universe of our patients with AHF. Significant changes were observed over time in some aspects of AHF management. Revisits decreased, but mortality rates remained unchanged. Only 2 other previously analyzed registries included patients with AHF treated in hospital EDs.
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Affiliation(s)
- Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital Universitario General de Alicante, Alicante, España
| | - Rosa Escoda
- Servicio de Urgencias, Hospital Clinic de Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic de Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, España
| | - Pablo Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Grupo de Investigación de Urgencias-HUCA, Oviedo, España
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | | | | | - Cristina Gil
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | - Marta Fuentes
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, España
| | - Héctor Alonso
- Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - Christian Muller
- Cardiology Department, University Hospital of Basel, Basel, Suiza
| | - Alexander Mebazaa
- Department of Anaesthesia and Intensive Care, INSERM UMR 942, Lariboisière Hospital, University of Paris - Diderot, Paris, Francia
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12
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Povar Marco J, Javierre Loris MÁ, Garcés Sanjosé C, Sánchez Miret JI. [Role of the hospital emergency department staff in the organ donation process: opinions of professionals working in the Spanish autonomous community of Aragon]. Emergencias 2015; 27:46-49. [PMID: 29077334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the opinion of hospital emergency department staff on their involvement in the process of organ and tissue procurement and on aspects that might improve their participation. MATERIAL AND METHODS Emergency department physicians and nurses responded to a questionnaire during a course on the procurement of organ and tissue donations in the emergency setting. A total of 149 questionnaires were received from 78 nurses (52%) and 71 emergency physicians (48%) from 10 hospitals. Sixty-three percent of the respondents worked in hospitals with intensive care units and 37% in centers without such units. RESULTS The respondents felt that the greatest difficulties in the donation process are related to communication and conveyance of information to the patient's families (39.6%) and to the assessment of prognosis (29.2%). The physicians felt that evaluating prognosis was the main hurdle, whereas the nurses thought that communication with the family presented the greatest problem (P=.021). They also felt that the health care professional's involvement in the donation process was the key to improving organ procurement (83.1%). The availability of protocols (47.2%) and the need for training opportunities (31%) were considered necessary for increasing the involvement of emergency department staff in the process. CONCLUSION The attitudes of hospital emergency department staff to organ and tissue donation are very positive, as suggested by their opinion that their own involvement in the process is the most important factor to target for improvement. These emergency physicians and nurses would like relevant protocols and training in the organ donation process.
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Affiliation(s)
- Javier Povar Marco
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España. Universidad de Zaragoza, España
| | | | - Cristina Garcés Sanjosé
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España. Universidad de Zaragoza, España
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Tudela P, Mòdol JM. [On hospital emergency department crowding]. Emergencias 2015; 27:113-120. [PMID: 29077353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent years have seen a range of measures deployed to curb crowding in hospital emergency departments, but as episodes of overcrowding continue to occur the discussion of causes and possible solutions remains open. The problem is universal, and efforts to revamp health care systems as a result of current socioeconomic circumstances have put emergency services in the spotlight. Consensus was recently achieved on criteria that define emergency department overcrowding. The causes are diverse and include both external factors and internal ones, in the form of attributes specific to a department. The factors that have the most impact, however, involve hospital organization, mainly the availability of beds and the difficulty of assigning them to emergency patients requiring admission. Crowding is associated with decreases in most health care quality indicators, as departments see increases in the number of patients waiting, the time until initial processing, and the time until a physician or nurse intervenes. Crowding is also associated with risk for more unsatisfactory clinical outcomes. This situation leads to dissatisfaction all around-of patients, families, and staff-as aspects such as dignity, comfort, and privacy deteriorate. Proposals to remedy the problem include assuring that the staff and structural resources of a facility meet minimum standards and are all working properly, facilitating access to complementary tests, and providing observation areas and short-stay units. The response of hospitals to the situation in emergency departments should include alternatives to conventional admission, through means for rapid diagnosis, day hospitals, and home hospitalization as well as by offering a clear response in cases where admission is needed, granting easier access to beds that are in fact available. For its part, the health system overall, should improve the care of patients with chronic diseases, so that fewer admissions are required. It is also essential to search for ways to bring the supply of necessary social and health care services more in step with demand.
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Affiliation(s)
- Pere Tudela
- Unidad de Corta Estancia- Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Facultat de Medicina, Universitat Autonònoma de Barcelona, España
| | - Josep Maria Mòdol
- Unidad de Corta Estancia- Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Facultat de Medicina, Universitat Autonònoma de Barcelona, España
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Miró Ò, Escalada X, Gené E, Boqué C, Jiménez Fábrega FX, Netto C, Alonso G, Sánchez P, Sánchez M. [Catalan hospital emergency department heads' opinions on the creation of a residency program for specializing in emergency medicine]. Emergencias 2015; 27:241-244. [PMID: 29087081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To understand the opinions of emergency department (ED) heads in Catalonia on their support for a residency program for specializing in emergency medicine (EM) and on their beliefs about the impact such a program would have. MATERIAL AND METHODS Heads of ED were asked if there would be support (from them, their staff, and their hospital) for a residency program to train specialists in EM. They were also asked their opinion on the impact that specialization would have on quality of care and costs in their department. Responses were compared by type of hospital and ED and by affiliation or not with the Spanish Society of Emergency Medicine (SEMES). RESULTS Responses were received from 79 of the 82 heads of hospital EDs in Catalonia (96%). They reported that favorable opinions toward creation of an EM specialization were held by them personally (93.7%; 95% CI, 85.8%-97.9%), by their in their departments (88.6%; 95% CI, 79.4%-94.7%), and by staff in their hospitals (48.7%; 95% CI, 36.7%-59.6%). A majority thought that the impact of specialization would be good in the short term (82.0%; 95% CI, 71.7%-89.8%) and in the medium and long term (94.8%; 95% CI, 87.2%-98.6%). The respondents were neutral about whether there would be an impact on costs (60.3%; 95% CI, 48.6%-71.2%). More heads in mid-sized hospitals, private hospitals, and nonmembers of SEMES thought that creating a specialty would raise ED costs (p<0,05). CONCLUSION The heads of Catalan ED, their staff, and their hospitals' staffs hold favorable opinions of the proposal to create a residency program allowing specialization in EM. They foresee short-, medium-, and long-term benefits for the EDs and scarce impact on costs.
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Affiliation(s)
- Òscar Miró
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Xavier Escalada
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Emili Gené
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Carme Boqué
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | | | - Cristina Netto
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Gilberto Alonso
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Pere Sánchez
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
| | - Miquel Sánchez
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Barcelona, España
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