RESUMO
BACKGROUND: Crowding in the emergency department (ED) has been studied intensively using complicated non-generic methods that may prove difficult to implement in a clinical setting. This study sought to develop a generic method to describe and analyse crowding from measurements readily available in the ED and to test the developed method empirically in a clinical setting. METHODS: We conceptualised a model with ED patient flow divided into separate queues identified by timestamps for predetermined events. With temporal resolution of 30 min, queue lengths were computed as Q(t + 1) = Q(t) + A(t) - D(t), with A(t) = number of arrivals, D(t) = number of departures and t = time interval. Maximum queue lengths for each shift of each day were found and risks of crowding computed. All tests were performed using non-parametric methods. The method was applied in the ED of Aarhus University Hospital, Denmark utilising an open cohort design with prospectively collected data from a one-year observation period. RESULTS: By employing the timestamps already assigned to the patients while in the ED, a generic queuing model can be computed from which crowding can be described and analysed in detail. Depending on availability of data, the model can be extended to include several queues increasing the level of information. When applying the method empirically, 41,693 patients were included. The studied ED had a high risk of bed occupancy rising above 100 % during day and evening shift, especially on weekdays. Further, a 'carry over' effect was shown between shifts and days. CONCLUSIONS: The presented method offers an easy and generic way to get detailed insight into the dynamics of crowding in an ED.
Assuntos
Aglomeração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Modelos Teóricos , Listas de Espera , Adolescente , Adulto , Idoso , Ocupação de Leitos/estatística & dados numéricos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
13% of the Danish population have tattoos and of these, 16% regret. In this case report, a 26-year-old woman presented to an accident and emergency department with blisters after laser removal of a tattoo on her lower leg. The blisters were only located at the laser-treated area of the tattoo, and they were successfully treated with local steroid class 3 and sun protection. Laser removal of tattoos is often associated with blistering and other painful skin reactions.