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1.
N Z Med J ; 134(1529): 39-44, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582706

RESUMEN

AIM: The Ministry of Health has mandated that all emergency department (ED) presentations are coded using the Systematised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) from 2021. The current ED reference set contains the non-specific term 'Referral for investigation' in the list of available chief presenting complaints (CPCs). The aim of this study was to determine the rate of use of this term and how often a more specific (and therefore more clinically useful) term was used. METHOD: This was a cross-sectional audit of routinely collected presenting complaint data, supplemented by a retrospective case note review. RESULTS: 'Referral for investigation' was used for 497/9,067 (5.5%, 95%CI 5-6%) presentations, with increased use for urgent cases. An alternative CPC was available in 467/497 (94.0%, 95%CI 92-96%) of cases from the existing reference set. Of 98 different CPCs, the common alternatives were: 'Chest pain' (6.4%), 'Shortness of breath' (4.2%) 'Abdominal pain' (3.6%), 'Altered mental status' (3.4%) and 'Postoperative complication' (3.2%). Six of 13 cardiac arrests and eight of 63 of multiple trauma cases were coded as 'Referral for investigation'. With the addition of two new terms to the New Zealand reference set ('Abnormal blood test' and 'Radiology request'), each of the remaining 30 presentations would have an alternative and more accurate CPC. CONCLUSION: 'Referral for investigation' should be removed from the New Zealand emergency department reference set for chief presenting complaints to improve data quality.


Asunto(s)
Urgencias Médicas/clasificación , Servicio de Urgencia en Hospital , Auditoría Médica/estadística & datos numéricos , Systematized Nomenclature of Medicine , Triaje/normas , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos
2.
N Z Med J ; 133(1526): 67-75, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33332341

RESUMEN

AIM: The Systematised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) coding system has been introduced to emergency departments in New Zealand, starting with the patient's chief presenting complaint (CPC). However, it is not known how accurate CPC coding at triage is, or whether coding accuracy varies by patient characteristics. The aim of this study was to determine the accuracy of CPC coding. METHOD: We compared the real-time triage recorded CPC with the presenting complaints recorded in medical notes by the treating clinician. Agreement was determined by exact CPC matches and the kappa statistic. RESULTS: From 1,000 consecutive presentations 852 were eligible (89 CPCs). Real-time CPC agreed with clinical notes in 514/852 (60.3%) cases. When real-time free text comments were included, agreement was 732/852 (85.9%). There were no differences by age, sex or ethnicity. Agreement for the common CPCs: 'trauma' (21%); 'abdominal pain' (11%), 'chest pain' 87 (10%) and 'shortness of breath' (8%) was substantial, k=0.66 (95% CI: 0.61, 0.70). Use of non-specific CPC such as 'referral for investigation' (5%) and 'general weakness/fatigue/unwell' (2%) was uncommon but associated with poor agreement. CONCLUSION: The accuracy of real-time coding for CPC using SNOMED-CT was reasonable, except for non-specific CPCs, which should be avoided where possible.


Asunto(s)
Urgencias Médicas/clasificación , Servicio de Urgencia en Hospital , Auditoría Médica/estadística & datos numéricos , Triaje/normas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
3.
Heart Fail Clin ; 16(3): 331-346, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32503756

RESUMEN

Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.


Asunto(s)
Técnicas de Imagen Cardíaca/métodos , Enfermedades Cardiovasculares , Urgencias Médicas/clasificación , Tratamiento de Urgencia/métodos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Humanos
4.
Ann Emerg Med ; 75(1): 66-74, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31353055

RESUMEN

STUDY OBJECTIVE: More than 4 billion passengers travel on commercial airline flights yearly. Although in-flight medical events involving adult passengers have been well characterized, data describing those affecting children are lacking. This study seeks to characterize pediatric in-flight medical events and their immediate outcomes, using a worldwide sample. METHODS: We reviewed the records of all in-flight medical events from January 1, 2015, to October 31, 2016, involving children younger than 19 years treated in consultation with a ground-based medical support center providing medical support to 77 commercial airlines worldwide. We characterized these in-flight medical events and determined factors associated with the need for additional care at destination or aircraft diversion. RESULTS: From a total of 75,587 in-flight medical events, we identified 11,719 (15.5%) involving children. Most in-flight medical events occurred on long-haul flights (76.1%), and 14% involved lap infants. In-flight care was generally provided by crew members only (88.6%), and physician (8.7%) or nurse (2.1%) passenger volunteers. Most in-flight medical events were resolved in flight (82.9%), whereas 16.5% required additional care on landing, and 0.5% led to aircraft diversion. The most common diagnostic categories were nausea or vomiting (33.9%), fever or chills (22.2%), and acute allergic reaction (5.5%). Events involving lap infants, syncope, seizures, burns, dyspnea, blunt trauma, lacerations, or congenital heart disease; those requiring the assistance of a volunteer medical provider; or those requiring the use of oxygen were positively correlated with the need for additional care after disembarkment. CONCLUSION: Most pediatric in-flight medical events are resolved in flight, and very few lead to aircraft diversion, yet 1 in 6 cases requires additional care.


Asunto(s)
Viaje en Avión/estadística & datos numéricos , Urgencias Médicas/epidemiología , Tratamiento de Urgencia/estadística & datos numéricos , Niño , Preescolar , Bases de Datos Factuales , Urgencias Médicas/clasificación , Femenino , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos
5.
Rev. bras. enferm ; 72(6): 1496-1503, Nov.-Dec. 2019.
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1042194

RESUMEN

ABSTRACT Objective: to describe the conception of justice of nurses and users regarding the Risk Classification in Emergency Unit; to analyze the conception of justice in the implementation of the Risk Classification in Emergency Unit from the user's recognition; to discuss, from Axel Honneth's Theory of Recognition, justice with the user in the Risk Classification in Emergency Unit. Method: qualitative research of descriptive, exploratory typology, which used action research as a method. Bardin's Content Analysis was carried out. Results: a category was created: "Justice versus Injustice" and three subcategories: "Autonomy/Freedom versus Heteronomy/Subordination"; "Communication versus Hermeneutic Problems"; "Contributions versus Conflicts". Final considerations: Embracement with Risk Classification presents difficulties in its interpretation and effectiveness; there are situations of disrespect that compete against the required ethics. Justice addressed by this study will be achieved by an emergency access system that meets user expectations, recognizing it as a subject of rights.


RESUMEN Objetivo: describir la concepción de justicia de enfermeros y usuarios en la Clasificación de Riesgo en Emergencia; analizar la concepción de justicia en la implementación de la Clasificación de Riesgo en la Emergencia a partir del reconocimiento del usuario; discutir, a partir de la Teoría del Reconocimiento de Axel Honneth, la justicia con el usuario en la Clasificación de Riesgo en Unidad de Emergencia. Método: investigación cualitativa de tipología descriptiva, exploratoria, que utilizó como método la investigación-acción. Análisis de Contenido de Bardin. Resultados: se organizó una categoría: "Justicia versus Injusticia" y tres subcategorías: "Autonomía/Libertad versus Heteronomía/Subordinación"; "Comunicación versus Problemas Hermenéuticos"; "Contribuciones versus Conflictos". Consideraciones finales: Acogida con Clasificación de Riesgo presenta dificultades en su interpretación y efectividad, con situaciones de incumplimiento que concurren contra la ética requerida. La justicia de que trata este estudio será alcanzada por un sistema de acceso a las emergencias que alcance las expectativas del usuario, reconociéndolo como sujeto de derechos.


RESUMO Objetivo: descrever a concepção de justiça de enfermeiros e usuários na Classificação de Risco em Emergência; analisar a concepção de justiça na implementação da Classificação de Risco na Emergência a partir do reconhecimento do usuário; discutir, a partir da Teoria do Reconhecimento de Axel Honneth, a justiça com o usuário na Classificação de Risco em Unidade de Emergência. Método: pesquisa qualitativa de tipologia descritiva, exploratória, que utilizou como método a pesquisa-ação. Análise de Conteúdo de Bardin. Resultados: foi organizada uma categoria: "Justiça versus Injustiça" e três subcategorias: "Autonomia/Liberdade versus Heteronomia/Subordinação"; "Comunicação versus Problemas Hermenêuticos"; "Contribuições versus Conflitos". Considerações finais: o Acolhimento com Classificação de Risco apresenta dificuldades em sua interpretação e efetividade, com situações de desrespeito que concorrem contra a ética requerida. A justiça de que trata esse estudo será alcançada por um sistema de acesso às emergências que atinja as expectativas do usuário, reconhecendo-o como sujeito de direitos.


Asunto(s)
Humanos , Femenino , Adulto , Justicia Social , Triaje/métodos , Medición de Riesgo/métodos , Urgencias Médicas/clasificación , Servicio de Urgencia en Hospital , Solución de Problemas , Factores de Tiempo , Comunicación , Conflicto Psicológico , Autonomía Personal , Investigación Cualitativa , Dominación-Subordinación , Escolaridad , Hermenéutica , Libertad , Persona de Mediana Edad , Personal de Enfermería en Hospital
6.
Rev Bras Enferm ; 72(6): 1496-1503, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31644736

RESUMEN

OBJECTIVE: to describe the conception of justice of nurses and users regarding the Risk Classification in Emergency Unit; to analyze the conception of justice in the implementation of the Risk Classification in Emergency Unit from the user's recognition; to discuss, from Axel Honneth's Theory of Recognition, justice with the user in the Risk Classification in Emergency Unit. METHOD: qualitative research of descriptive, exploratory typology, which used action research as a method. Bardin's Content Analysis was carried out. RESULTS: a category was created: "Justice versus Injustice" and three subcategories: "Autonomy/Freedom versus Heteronomy/Subordination"; "Communication versus Hermeneutic Problems"; "Contributions versus Conflicts". FINAL CONSIDERATIONS: Embracement with Risk Classification presents difficulties in its interpretation and effectiveness; there are situations of disrespect that compete against the required ethics. Justice addressed by this study will be achieved by an emergency access system that meets user expectations, recognizing it as a subject of rights.


Asunto(s)
Urgencias Médicas/clasificación , Servicio de Urgencia en Hospital , Medición de Riesgo/métodos , Justicia Social , Triaje/métodos , Adulto , Comunicación , Conflicto Psicológico , Dominación-Subordinación , Escolaridad , Femenino , Libertad , Hermenéutica , Humanos , Persona de Mediana Edad , Personal de Enfermería en Hospital , Autonomía Personal , Solución de Problemas , Investigación Cualitativa , Factores de Tiempo
7.
Semin Fetal Neonatal Med ; 24(6): 101030, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31563413

RESUMEN

The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the delivery room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the delivery room including heart rate, cardiac output, cerebral oxygenation and echocardiography.


Asunto(s)
Anomalías Cardiovasculares , Sistema Cardiovascular/fisiopatología , Enfermedades del Recién Nacido , Manejo de Atención al Paciente/métodos , Anomalías Cardiovasculares/diagnóstico , Anomalías Cardiovasculares/etiología , Anomalías Cardiovasculares/fisiopatología , Anomalías Cardiovasculares/terapia , Urgencias Médicas/clasificación , Humanos , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Recién Nacido/terapia , Neonatología/métodos , Ultrasonografía Prenatal/métodos
8.
J Dtsch Dermatol Ges ; 17(10): 1018-1026, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31479574

RESUMEN

BACKGROUND AND OBJECTIVES: Rising numbers of patients consulting emergency units are associated with an increased demand for material and personnel. In order to better quantify these resources, we performed an analysis of diagnostic procedures, treatment types, and the quantity and educational level of staff involved in emergency consultations. PATIENTS AND METHODS: The study was conducted as a prospective single-center survey over twelve months in the dermatology unit of a Germany university hospital. 3155 consultations were included by consecutive sampling. RESULTS: Diagnostic tests (e.g. microbiological swab, blood testing, punch biopsy) were performed in 29 % of all consultations. Physicians prescribed treatment in 70 % of cases, with steroids and antihistamines being the most frequent topical and systemic treatment, respectively. Each patient was seen by at least one physician and a nurse, and in 25 % of cases an additional physician was involved. Less than thirty minutes was required for the consultation in the vast majority of cases. On average, emergency consultations required two hours per day of the treating physician's time, not including the time of other involved staff such as nurses and laboratory technicians. CONCLUSIONS: This study demonstrates the extent of resources involved in the treatment of dermatological emergency consultations.


Asunto(s)
Dermatología/estadística & datos numéricos , Urgencias Médicas/epidemiología , Recursos en Salud/estadística & datos numéricos , Enfermedades de la Piel/patología , Recolección de Datos , Urgencias Médicas/clasificación , Servicio de Urgencia en Hospital/estadística & datos numéricos , Alemania/epidemiología , Antagonistas de los Receptores Histamínicos/uso terapéutico , Hospitales Universitarios , Humanos , Enfermeras y Enfermeros/estadística & datos numéricos , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Estudios Prospectivos , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Enfermedades de la Piel/terapia , Esteroides/uso terapéutico , Encuestas y Cuestionarios
9.
Emergencias ; 31(4): 234-238, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31347802

RESUMEN

OBJECTIVES: To estimate the volume of patient-initiated visits to the emergency department without follow-up by a primary care physician, and to identify factors related to this practice. MATERIAL AND METHODS: Retrospective, observational study of patients attended in a tertiary care hospital emergency department. We used a cluster/systematic sampling method to select 0.05% of the episodes discharged home every month. The following data were extracted: demographic variables, care times, prior primary care for the same episode, triage level, diagnosis, cost of prescriptions on discharge, instructions for follow-up, and adherence to those instructions. Associations were explored using multivariate logistic regression modelling. RESULTS: A total of 1277 episodes were analyzed; 48.1% were patient-initiated visits without primary care follow-up. These visits were associated with the following variables: young patients (P = .002) without prior primary care (odds ratio [OR], 1.74; 95% CI, 1.34-2.28); visits between 10 PM and 4 AM (OR, 2.43; 95% CI, 1.55-3.80); triage level 4-5 (OR, 1.33; 95% CI, 1.04-1.69); ophthalmologic emergency (OR, 1.64; 95% CI, 1.12-2.41); a prescription cost of less than €3 (OR, 2.39; 95% CI, 1.87-3.06); and instruction to seek follow-up on discharge (OR, 1.9; 95% CI, 1.37-2.65). CONCLUSION: Half of patients who independently seek care from the emergency department and are discharged home do not later seek care at their primary care clinic. The emergency physician should insist on the importance of ongoing primary care.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Atención Posterior/estadística & datos numéricos , Factores de Edad , Anciano , Continuidad de la Atención al Paciente , Urgencias Médicas/clasificación , Urgencias Médicas/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Centros de Atención Terciaria , Factores de Tiempo , Triaje/clasificación , Adulto Joven
10.
BMJ Open ; 9(5): e024896, 2019 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-31064804

RESUMEN

OBJECTIVES: To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany. DESIGN: Prospective cohort study. SETTING: Single centre University Hospital Emergency Department. PARTICIPANTS: Adult, non-surgical ED patients. EXPOSURE: A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS. PRIMARY AND SECONDARY OUTCOME MEASURES: Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality). RESULTS: A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420). CONCLUSIONS: The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care. TRIAL REGISTRATION NUMBER: U1111-1119-7564; Post-results.


Asunto(s)
Servicios Médicos de Urgencia , Control de Acceso , Medicina General/organización & administración , Ajuste de Riesgo/organización & administración , Medición de Riesgo , Triaje/métodos , Adulto , Urgencias Médicas/clasificación , Urgencias Médicas/epidemiología , Servicios Médicos de Urgencia/organización & administración , Servicios Médicos de Urgencia/normas , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Control de Acceso/organización & administración , Control de Acceso/normas , Alemania/epidemiología , Humanos , Efectos Adversos a Largo Plazo/mortalidad , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Medición de Riesgo/métodos , Medición de Riesgo/normas
11.
BMJ Open ; 9(3): e024927, 2019 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-30928937

RESUMEN

OBJECTIVE: Video laryngoscopes are used for managing difficult airways. This study compared three video laryngoscopes' (Pentax-Airway Scope [Pentax], King Vision[King] and McGrath MAC [McGrath]) performances with the Macintosh direct laryngoscope (Macintosh) as emergency tracheal intubations (TIs) reference. DESIGN: Retrospective cohort study. SETTING: The emergency department (ED) and the intensive care unit (ICU) of two Japanese tertiary-level hospitals. PARTICIPANTS: All consecutive video-recorded emergency TI cases in EDs and ICUs between December 2013 and June 2015. PRIMARY OUTCOME MEASURES: The primary study endpoint was first-pass intubation success. A subgroup analysis examined the first-pass intubation success of expert versus non-expert operators. A logistic regression analysis was performed to identify the predictors of first-pass intubation success. RESULTS: A total of 287 emergency TIs were included. The first-pass intubation success rates were 78%, 58%, 78% and 58% for the Pentax, King, McGrath and Macintosh instruments, respectively (p=0.004, Fisher's exact test). The non-expert operators' success rates were significantly higher (p=0.00004, Fisher's exact test) for the Pentax (87%) and McGrath (78%) instruments than that for the King (50%) and Macintosh (46%) instruments, unlike that of the experts (67%, 67%, 78% and 78% for Pentax, McGrath, King and Macintosh, respectively; p=0.556, Fisher's exact test). After TI indication, difficult airway characteristics, and expert versus non-expert operator parameters adjustments, the Pentax (OR=3.422, 95% CI 1.551 to 7.550; p=0.002) and McGrath (OR= 3.758, CI 1.640 to 8.612; p=0.002) instruments showed significantly higher first-pass intubation success odds when compared with the Macintosh laryngoscope (reference, OR=1). The King instrument, however, (OR=1.056; 95% CI 0.487 to 2.289, p=0.889) failed to show any significant superiority. CONCLUSION: The Pentax and McGrath laryngoscopes showed significantly higher emergency TI first-pass intubation success rates than the King laryngoscope when compared with the Macintosh laryngoscope, especially for non-expert operators. TRIAL REGISTRATION NUMBER: UMIN000027925; Results.


Asunto(s)
Urgencias Médicas/clasificación , Intubación Intratraqueal/instrumentación , Laringoscopios , Laringoscopía/instrumentación , Grabación en Video , Adulto , Anciano , Manejo de la Vía Aérea/métodos , Competencia Clínica/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/métodos , Japón , Laringoscopios/clasificación , Laringoscopios/normas , Laringoscopía/efectos adversos , Laringoscopía/métodos , Masculino , Ensayo de Materiales/métodos , Grabación en Video/métodos , Grabación en Video/estadística & datos numéricos
12.
Enferm. clín. (Ed. impr.) ; 29(supl.1): 101-104, mar. 2019. tab, graf
Artículo en Inglés | IBECS | ID: ibc-184784

RESUMEN

Objective: Triage is basically a categorization process to prioritize various treatments for patients based on the types of disease, severity, prognosis and resource availability. However, the term triage is more appropriate to be used in the context of natural disaster or mass casualties. Within the context of emergency situation in emergency department, the term triage refers to a method used to assess the severity of patients’ condition, determine the level of priority, and mobilize the patients to the suitable care unit. ESI is a new concept of triage using five scales in classifying the patients in emergency department. The real implementation of this concept demands nurses have to immediately make assessment about patients' condition right away, besides they must give their final decision, whether to move the patients to the ward or to let them leave the hospital. Method: This research was done using Pretest-Posttest one Group Design, involving 21 nurses in the Emergency Department of RSUD Pariaman as research respondents. Before respondents were introduced to ESI method, their basic skills had been previously evaluated, which evaluation results were compared to the after-treatment results. A set of questionnaires consisting of 10 cases were used as research instrument. Results: The result of this research showed that the value or rank difference between common triage and ESI triage categorization was positive (N). The mean rank was found at 11.00, while the sum of positive rank was 231.0 as shown in Asymp. Sig. (2-tailed) score of 0.00 lower than 0.05. Therefore, the null hypothesis was rejected. Conclusions: There were differences in triage categorization before and after respondents were introduced to ESI method


No disponible


Asunto(s)
Humanos , Adulto , Urgencias Médicas/clasificación , Índice de Severidad de la Enfermedad , Triaje/métodos , Servicio de Urgencia en Hospital , Encuestas y Cuestionarios
13.
Enferm Clin ; 29 Suppl 1: 101-104, 2019 03.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30733125

RESUMEN

OBJECTIVE: Triage is basically a categorization process to prioritize various treatments for patients based on the types of disease, severity, prognosis and resource availability. However, the term triage is more appropriate to be used in the context of natural disaster or mass casualties. Within the context of emergency situation in emergency department, the term triage refers to a method used to assess the severity of patients' condition, determine the level of priority, and mobilize the patients to the suitable care unit. ESI is a new concept of triage using five scales in classifying the patients in emergency department. The real implementation of this concept demands nurses have to immediately make assessment about patients' condition right away, besides they must give their final decision, whether to move the patients to the ward or to let them leave the hospital. METHOD: This research was done using Pretest-Posttest one Group Design, involving 21 nurses in the Emergency Department of RSUD Pariaman as research respondents. Before respondents were introduced to ESI method, their basic skills had been previously evaluated, which evaluation results were compared to the after-treatment results. A set of questionnaires consisting of 10 cases were used as research instrument. RESULTS: The result of this research showed that the value or rank difference between common triage and ESI triage categorization was positive (N). The mean rank was found at 11.00, while the sum of positive rank was 231.0 as shown in Asymp. Sig. (2-tailed) score of 0.00 lower than 0.05. Therefore, the null hypothesis was rejected. CONCLUSIONS: There were differences in triage categorization before and after respondents were introduced to ESI method.


Asunto(s)
Urgencias Médicas/clasificación , Índice de Severidad de la Enfermedad , Triaje/métodos , Adulto , Servicio de Urgencia en Hospital , Humanos , Encuestas y Cuestionarios
14.
Gynecol Obstet Fertil Senol ; 47(4): 342-346, 2019 04.
Artículo en Francés | MEDLINE | ID: mdl-30686726

RESUMEN

BACKGROUND: Considering its benefits, immediate skin-to-skin should be applied irrespective of the way of delivery. While it is increasingly applied in case of vaginal delivery, it remains difficult to implement in case of caesarean section. OBJECTIVE: To estimate the degree of implementation of skin-to-skin in case of caesarean section. METHODS: Survey in immediate postpartum with a continuous series of patients having given birth by caesarean - whether scheduled or not - in a level 3 hospital systematically realizing skin-to-skin in case of vaginal delivery. The patients were included if the caesarean section had been realized between 16/11/17 and 28/11/17. RESULTS: Thirty-five women gave birth by caesarean section during the period of study, among which 26 were planned (74%). The emergency levels were varied: 18 had a green code (51%), 12 an orange code (34%) and 5 a red code (14%). Forty-six percent of the newborn children were placed skin-to-skin. The frequency of skin-to-skin was closely linked to the planned character of the caesarean section (89 vs. 31%, P=0.005), as well as its color code (green 72%, orange 25%, red 0%). In case of impossibility to realize skin-to-skin in the course of the caesarean, the reasons were mainly related to the maternal state (63%) (malaise, bleeding, pain). In this situation, skin-to-skin was proposed to the spouse in 83% of cases and realized in recovery room with the mother in 82% of the cases. CONCLUSION: Skin-to-skin is feasible during caesarean section, regardless of the color code of the procedure.


Asunto(s)
Cesárea , Parto , Tacto , Anestesia General , Anestesia Local , Toma de Decisiones Clínicas/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas/clasificación , Femenino , Francia , Humanos , Recién Nacido , Parto/psicología , Embarazo
15.
J Healthc Risk Manag ; 38(3): 32-41, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30156353

RESUMEN

The common and frequent use of emergency codes by hospitals to communicate during life-threatening emergencies routinely segregates hospital staff from patients, visitors, and first-responders during emergencies by providing each group with a different level of information regarding the threat. By relying on codes instead of plain language to communicate during an emergency, a hospital may introduce ambiguity into a potentially life-threatening situation. Consequently, this means that coded alerts may endanger staff, patients, and visitors rather than protecting them from threats. This paper will maintain that (1) relying on codes, even standardized color codes for hospitals, interferes with the full integration of health care into the National Incident Management System (NIMS); (2) that planning to use plain language notifications improves coordination among response partners and ultimately increases safety for hospital patients, staff, and visitors; and (3) that the change to plain language is both practical and possible. This paper identifies both real world events and studies that demonstrate the benefits of using plain language alerts with directive messaging to elicit the desired response among members of the public during emergencies. This paper also presents guides that hospitals can use to transition from coded emergency messaging to plain language emergency alerts.


Asunto(s)
Comunicación , Urgencias Médicas/clasificación , Servicios Médicos de Urgencia/normas , Servicio de Urgencia en Hospital/normas , Hospitales/normas , Clasificación Internacional de Enfermedades/normas , Terminología como Asunto , Guías como Asunto , Humanos , Encuestas y Cuestionarios
16.
J Fr Ophtalmol ; 41(8): 708-717, 2018 Oct.
Artículo en Francés | MEDLINE | ID: mdl-30220447

RESUMEN

INTRODUCTION: The steady increase in the number of visits to the various emergency services combined with the decrease in medical demographics, make it necessary to optimize triage of patients to improve their care. The purpose of this study was to evaluate the pertinence of our triage questionnaire in the classification of ophthalmologic emergencies by severity. METHODS: We used a monocentric cross-sectional study. From September 5 through September 25 2017, 858 patients who had all been seen in the ophthalmology emergency department of Pierre Paul Riquet Hospital of Toulouse university medical center and had responded to the triage nurse questionnaire were included. According to the symptoms presented or not by the patient, a color code was attributed (GREEN, ORANGE or RED) in order of increasing level of emergency. For each patient, we compared the severity of the final diagnosis by Base Score with the level of emergency established by our questionnaire. RESULTS: There were 118 "GREEN" patients, 606 "ORANGE" patients and 134 "RED." We were able to analyze 822 patients. 21.65% of patients were correctly classified, 73.36% were overestimated (of which 87.06% by one level and 12.94% by two levels of severity), and 4.99% were underestimated (of which 90.24% by one level and 9.76% by two levels). CONCLUSION: Our current triage questionnaire is not sufficiently discriminating for effective triage of ophthalmologic emergencies. It often overestimates minor emergencies, causing a delay in treating other emergencies. We propose a new questionnaire modified according to the results obtained during our study.


Asunto(s)
Técnicas de Diagnóstico Oftalmológico , Urgencias Médicas , Pautas de la Práctica en Enfermería , Encuestas y Cuestionarios , Triaje , Adulto , Anciano , Estudios Transversales , Técnicas de Diagnóstico Oftalmológico/enfermería , Técnicas de Diagnóstico Oftalmológico/normas , Técnicas de Diagnóstico Oftalmológico/estadística & datos numéricos , Urgencias Médicas/clasificación , Urgencias Médicas/epidemiología , Urgencias Médicas/enfermería , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología , Pautas de la Práctica en Enfermería/normas , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Triaje/métodos , Triaje/normas
17.
Gynecol Obstet Fertil Senol ; 46(7-8): 575-579, 2018.
Artículo en Francés | MEDLINE | ID: mdl-29983276

RESUMEN

OBJECTIVE: Evaluation of the compliance of the color codes protocol according to the indication of ceasarean section and on the decision-to-delivery interval according to the color code, the operator and the period. METHODS: This is a retrospective monocentric study including women who had to undergo an emergency cesarean section after 37 weeks of amenorrhea in the Jeanne-de-Flandre hospital between 2015 and 2017. Three groups were created: cesarean section with green code, orange code and red code. We compared population characteristics and obstetrical data, then drew up a reassessed color code and analyzed the correspondence between the initial color code and the reassessed one. Finally, we considered the respect of decision-to-delivery interval according to color code, operator level and period. RESULTS: Eight hundred and eighty-one patients were included, amongst which 303 (34%) fell into the green c-section, 353 (40%) into the orange c-section and 225 (26%) into the red c-section. In the three groups, there was a significant consistency between the initial color code and the reassessed one, with a kappa agreement test of 95% 0.95 (0.93-0.97). The average decision-to-delivery interval was 37±20min for the green c-section, 20±6min for the orange c-section and 12±3min for the red c-section with a significant respect of the decision-to-delivery interval according to color code P<0.001. The decision-to-delivery interval was similar considering the operator level and the period. CONCLUSION: In our study, we observed the compliance with color code regarding the indication of ceasarean section and the respect of the decision-to-delivery interval whatever the time of occurrence and the operator.


Asunto(s)
Cesárea/clasificación , Toma de Decisiones Clínicas/métodos , Urgencias Médicas/clasificación , Adhesión a Directriz/estadística & datos numéricos , Adulto , Parto Obstétrico , Femenino , Francia , Humanos , Obstetricia/métodos , Embarazo , Estudios Retrospectivos , Factores de Tiempo
18.
J Emerg Manag ; 16(2): 73-79, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29791001

RESUMEN

The nature of an emergency is not predictable, and no two emergencies are alike. In response to this unpredictable nature, healthcare facilities across the nation have adopted a system of emergency codes to notify staff of an emergent situation, often without alerting patients and visitors to the crises. However, the system of emergency codes varies significantly within most states and even within healthcare coalition regions. This variation in codes leads to not only the potential for staff confusion, considering many healthcare providers work within multiple healthcare centers, but also decreases the amount of transparency a healthcare center projects to its patients and visitors. The research conducted as part of this study indicated that an overwhelming majority of healthcare professionals would prefer voluntary plain language emergency code standardization to the current individual code systems.


Asunto(s)
Actitud del Personal de Salud , Urgencias Médicas/clasificación , Hospitales/normas , Terminología como Asunto , Humanos , Encuestas y Cuestionarios , Estados Unidos
19.
Cochrane Database Syst Rev ; 2: CD002097, 2018 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-29438575

RESUMEN

BACKGROUND: In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective. This is the first update of the original Cochrane Review published in 2012. OBJECTIVES: To assess the effects of locating primary care professionals in hospital EDs to provide care for patients with non-urgent health problems, compared with care provided by regularly scheduled emergency physicians (EPs). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library; 2017, Issue 4), MEDLINE, Embase, CINAHL, PsycINFO, and King's Fund, from inception until 10 May 2017. We searched ClinicalTrials.gov and the WHO ICTRP for registered clinical trials, and screened reference lists of included papers and relevant systematic reviews. SELECTION CRITERIA: Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs attending to patients with non-urgent conditions, as compared to the care provided by regularly scheduled EPs.  DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified four trials (one randomised trial and three non-randomised trials), one of which is newly identified in this update, involving a total of 11,463 patients, 16 general practitioners (GPs), 9 emergency nurse practitioners (NPs), and 69 EPs. These studies evaluated the effects of introducing GPs or emergency NPs to provide care to patients with non-urgent problems in the ED, as compared to EPs for outcomes such as resource use. The studies were conducted in Ireland, the UK, and Australia, and had an overall high or unclear risk of bias. The outcomes investigated were similar across studies, and there was considerable variation in the triage system used, the level of expertise and experience of the medical practitioners, and type of hospital (urban teaching, suburban community hospital). Main sources of funding were national or regional health authorities and a medical research funding body.There was high heterogeneity across studies, which precluded pooling data. It is uncertain whether the intervention reduces time from arrival to clinical assessment and treatment or total length of ED stay (1 study; 260 participants), admissions to hospital, diagnostic tests, treatments given, or consultations or referrals to hospital-based specialist (3 studies; 11,203 participants), as well as costs (2 studies; 9325 participants), as we assessed the evidence as being of very low-certainty for all outcomes.No data were reported on adverse events (such as ED returns and mortality). AUTHORS' CONCLUSIONS: We assessed the evidence from the four included studies as of very low-certainty overall, as the results are inconsistent and safety has not been examined. The evidence is insufficient to draw conclusions for practice or policy regarding the effectiveness and safety of care provided to non-urgent patients by GPs and NPs versus EPs in the ED to mitigate problems of overcrowding, wait times, and patient flow.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Medicina General/organización & administración , Atención Primaria de Salud/organización & administración , Aglomeración , Urgencias Médicas/clasificación , Medicina de Emergencia/organización & administración , Medicina de Emergencia/estadística & datos numéricos , Enfermería de Urgencia/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Pruebas Hematológicas/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Enfermeras Practicantes/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Radiografía/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Derivación y Consulta/estadística & datos numéricos , Triaje
20.
Ann Biol Clin (Paris) ; 76(1): 23-44, 2018 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-29386144

RESUMEN

The SFBC Working Group on critical care testing describes in this paper the SFBC recommendations for the determination of maximal turnaround times (TAT) for laboratory medicine examination in emergency conditions. The table presented in a previous paper was updated, taken into account the clinical situations, as well as the emergency response capabilities of the medical laboratory. These new French recommendations must to be based to each local situation in a clinical-biological context between the physicians and the specialist in Lab Medicine.


Asunto(s)
Cuidados Críticos , Ciencia del Laboratorio Clínico/normas , Pruebas en el Punto de Atención/normas , Práctica Profesional/normas , Acreditación , Cuidados Críticos/clasificación , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cuidados Críticos/normas , Urgencias Médicas/clasificación , Francia , Humanos , Ciencia del Laboratorio Clínico/organización & administración , Sociedades Médicas/normas
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