Quaternary low-temperature serpentinization and carbonation in the New Caledonia ophiolite.

The low-temperature alteration (< 150 °C) of ophiolites by infiltrated meteoric waters removes atmospheric CO2 through mineral carbonation and is assumed to generate H2 and possibly CH4 according to so-called serpentinization reactions. This overall alteration pattern is primarily constrained by the chemical composition of alkaline springs that are issued in several ophiolites worldwide. Here we report on the fingerprint, as veinlet mineralization, of the reactive percolation of such meteoric waters in the New Caledonia ophiolite (Massif du Sud). The mineralization which resulted from carbonation and serpentinization reactions, is young (< 2 Ma) and formed at a temperature of ca. 95 °C. It is mainly composed of lizardite, dolomite, magnetite ± pyroaurite. Thermochemical simulation of mineral-water equilibria shows that the percolating aqueous fluid was alkaline and H2 bearing. The δ13C of dolomite is exceptionally high, between 7.1 and up to 17.3‰, and is interpreted as evidence of low-temperature methanogenesis. Overall, the percolating fluid had a chemical composition similar to that of the waters issued today in the (hyper)alkaline springs of the Massif du Sud. The studied veinlets are thus interpreted as a sample of the plumbing system that fed an ancient Quaternary alkaline spring in the area.

Barren ground depressions, natural H2 and orogenic gold deposits: Spatial link and geochemical model.

A review of the localities in continental rocks where H2-rich gases have been reported, showed that they are mainly located near orogenic gold deposits. Two types of geomorphological features known as markers of gas venting in sedimentary basins were also systematically observed near orogenic gold deposits on satellite images. They consist in both barren ground depressions and high densities of small (<20 m in diameter) circular- and comet-shaped white spots in 32 and 7 localities, respectively. Point pattern analysis revealed that the white spots are self-organized, and similar to previously described vegetation patterns associated with termite mounds and fairy circles. We proposed a geochemical model to account for this relationship between orogenic gold deposits, H2 emanations and geomorphological features. Fe­carbonates are ubiquitous mineral products associated with gold mineralization. They can further dissolve in the presence of aqueous fluid due to their high reactivity below 200 °C to produce magnetite and up to ∼1 mol H2 per kg of rock along with ∼3 mol/kg CO2. This process induces a solid volume decrease of 50 %. Therefore, we propose that Fe­carbonate dissolution is (1) the primary source of H2 in orogenic gold deposit areas, and (2) involved in the formation of the geomorphological structures reported here, providing a new framework to understand their seemingly complex formation. Ground depressions and white spots are possible tools for gold exploration. Actually, we identified four new areas where we suspect possible orogenic gold deposits. The association between H2-rich gas and ground depressions was also made near other formations containing Fe­carbonates such as iron formations and carbonatites. This suggests that H2 production through Fe­carbonate dissolution is not restricted to gold deposits. The global H2 production in crustal rocks associated with Fe­carbonate alteration is estimated to 3 × 105 mol/yr.

Real-time monitoring of aqueous Hg2+ reduction dynamics by magnetite/iron metal composite powders synthesized hydrothermally.

An iron-based powder material composed of zerovalent iron (8 wt.%) and magnetite (92 wt.%), has been synthesized hydrothermally at 200 °C from zero-valent iron. Its effect on the reduction of aqueous Hg2+ into gaseous Hg0 has been investigated at ambient conditions for pH comprised between 4 and 8.5. The production of Hg0 was monitored with an online mercury vapor analyzer at the picogram level for concentrations of iron-based composite of a few tenths of mg L-1. Starting from a solution having an Hg2+ concentration of 25 ng L-1 at pH = 4, a succession of two Hg0 production events was recorded. The first event is related to the Hg2+ reduction by ZVI which fully dissolved within the first hours. Upon ZVI consumption, pH drifted towards the pH window where magnetite can efficiently reduce Hg2+ at the hour timescale, resulting in a second Hg0 production peak. The combined use of ZVI and magnetite to remove aqueous Hg2+ by formation of Hg0 (volatile) under mild acidic pH allows (1) to maximize the Hg2+ reduction rate and (2) to take benefit of the longer lifetime of magnetite compared to ZVI.

Reconnecting health through innovation.

Learning health systems identify appropriate data to improve their performance and population health. The pandemic has shown that a proper response depends on using data from patients' needs, scientific research, hospital capacity, digital innovations, and stakeholder knowledge. Academic health centres play a role in data collection, information synthesis, and decision making supported by digital innovations. The results obtained by an academic centre and network in Quebec have demonstrated the value of integrating these elements during the pandemic and beyond.

Reducing social isolation during the COVID-19 pandemic: Assessing the contribution of courtesy phone calls by volunteers.

CONTEXT: During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing face-to-face contact in order to protect patients, visitors and staff. These measures led to social isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l'Université de Montréal, a teaching hospital) shifted from in-person visits to courtesy telephone calls delivered by volunteers from CHUM's Volunteers, Recreation and Leisure Department. OBJECTIVES: To study: (1) the contribution made by these calls to reducing isolation and their limitations, (2) how the calls can be improved, and (3) whether they should be maintained, based on the views of patients and volunteers. METHODOLOGY: This study examined two populations. The first one consisted of 189 adult patients hospitalized at CHUM who received a courtesy phone call from a volunteer and the second one consisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected from patients and volunteers through questionnaires and a Smartsheet. The patient questionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the volunteer and sociodemographic questions. The volunteer questionnaire evaluated the appropriateness of the technology for the intervention, the support and training received, the impacts of the courtesy phone call on both the patients and the volunteers, an experience report and sociodemographic information. In addition, a focus group was held with 7 volunteers. Then the verbatim were transcribed and analyzed using QDA miner software. RESULTS: From April 27, 2020 to September 5, 2020 more than 11,800 calls were made, mainly concerning hospitalization conditions or home follow-ups (n = 83), and relationships with relatives, friends, and family (n = 79). For 73.6% of hospitalized patients, the courtesy calls from volunteers were a good response to their needs, and 72% of volunteers agreed. 64.5% of patients felt less isolated and 40% of volunteers felt useful. CONCLUSION: Our data suggest that patients felt less isolated during their hospitalization because of the courtesy calls made by the volunteers, that smartphones could also be used for video calls and, finally, that maintaining this type of service seems as relevant after as during a pandemic to provide social interactions to people isolated for medical reasons.

Will telemedicine survive after COVID-19?

During the last 20 years, telemedicine has evolved in Quebec despite several barriers. We studied how a university health centre in Montreal implemented a strategy to enhance the use of telemedicine with the deployment of appropriate infrastructures, continuous training, and the use of advanced technologies, before and during the pandemic. COVID-19 accelerated the use of telemedicine by overcoming some pre-existing barriers. However, telemedicine was mainly limited to a distance consultation during the pandemic using telephone calls or videoconference. The future of telemedicine depends on lifting these obstacles. We need to better define telemedicine and in-person medicine to guarantee the quality of medical and professional acts. We propose some strategies to achieve these goals, combining cultural change, continuous training, new technologies to improve quality of care, and a vision of healthcare with telemedicine oriented on value creation.

A model of an agile organization designed to better manage the COVID-19 crisis.

COVID-19 strongly hit healthcare organizations due to three factors: the lack of knowledge of this new virus, the fear of the people, and the continuous modifications in the management of the crisis. This situation required flexibility and adaptability of organizations, as our university health centre demonstrated. It relied on a decentralized model of management based on three pillars: a culture of innovation and creativity, an agile organizational structure, and an open innovation ecosystem and network. These assets were already developed prior to the onset of COVID-19 and helped our organization to better respond to the crisis.

Impact of Failure of Noninvasive Ventilation on the Safety of Pediatric Tracheal Intubation.

OBJECTIVES: Noninvasive ventilation is widely used to avoid tracheal intubation in critically ill children. The objective of this study was to assess whether noninvasive ventilation failure was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. DESIGN: Prospective multicenter cohort study of consecutive intubated patients using the National Emergency Airway Registry for Children registry. SETTING: Thirteen PICUs (in 12 institutions) in the United States and Canada. PATIENTS: All patients undergoing tracheal intubation in participating sites were included. Noninvasive ventilation failure group included children with any use of high-flow nasal cannula, continuous positive airway pressure, or bilevel noninvasive ventilation in the 6 hours prior to tracheal intubation. Primary tracheal intubation group included children without exposure to noninvasive ventilation within 6 hours before tracheal intubation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Severe tracheal intubation-associated events (cardiac arrest, esophageal intubation with delayed recognition, emesis with aspiration, hypotension requiring intervention, laryngospasm, pneumothorax, pneumomediastinum) and severe oxygen desaturation (< 70%) were recorded prospectively. The study included 956 tracheal intubation encounters; 424 tracheal intubations (44%) occurred after noninvasive ventilation failure, with a median of 13 hours (interquartile range, 4-38 hr) of noninvasive ventilation. Noninvasive ventilation failure group included more infants (47% vs 33%; p < 0.001) and patients with a respiratory diagnosis (56% vs 30%; p < 0.001). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events (5% vs 5% without noninvasive ventilation; p = 0.96) but was associated with severe desaturation (15% vs 9% without noninvasive ventilation; p = 0.005). After controlling for baseline differences, noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events (p = 0.35) or severe desaturation (p = 0.08). In the noninvasive ventilation failure group, higher FIO2 before tracheal intubation (≥ 70%) was associated with severe tracheal intubation-associated events. CONCLUSIONS: Critically ill children are frequently exposed to noninvasive ventilation before intubation. Noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events or severe oxygen desaturation compared to primary tracheal intubation.

Adaptation and validation of a nursing competencies framework for clinical practice on a continuum of care from childhood to adulthood: A Delphi study.

BACKGROUND: Too few of nursing competencies framework exceed applicability to a given environment, are validated by a research process or used to guide continuing development of nursing competencies. OBJECTIVES: The study objectives were: 1) to adapt and validate a nursing competencies framework from the continuum of care from childhood to adulthood and 2) to explore implementation strategies. DESIGN: A collaborative approach including nurses from different practice perspectives. A modified Delphi method supported the adaptation and the validation of a nursing competencies framework. SETTING: This study was conducted in a pediatric and an adult care university hospitals in Montreal. PARTICIPANTS: Forty-two nurses were recruited from both university hospitals. METHODS: A modified Delphi study was conducted. An online questionnaire, containing dichotomous and open-ended questions, was used to collect data on the nursing competencies framework and the suggested implementation strategies for its use. Consensus percentage was calculated, and thematic analysis was used to analyze nurses' comments and implementation strategies suggested. RESULTS: The nursing competencies framework (NCF), adapted and validated in this study, includes seven competencies and four development stages, from advanced beginner to clinical expert nurses. After three rounds, the nursing competencies framework describes the professional role from the continuum of care from childhood to adulthood, and proposes a self-assessment tool that promotes professional development and continuing education of nurses. Moreover, four strategies for implementing the framework in the clinical setting obtained a consensus of 70% or more. CONCLUSIONS: A nursing competencies framework was validated by a rigorous research process and adapted to diverse contexts of care. The results revealed a common vision of the nursing practice for patients and their families on the life course from childhood to adulthood. This innovative framework carries the potential to be a relevant and unique reference tool. The nursing competencies framework can provide guidance for the development of nurses' competencies in clinical setting. Additionally, it is a relevant reference that should be use for knowing the scope and the standards of the professional practice in nursing education.

Adoption of infection prevention and control practices by healthcare workers in Québec: A qualitative study.

OBJECTIVE: To describe barriers and facilitators to the adoption of recommended infection prevention and control (IPC) practices among healthcare workers (HCWs). METHODS: A qualitative research design was used. Individual semistructured interviews with HCWs and observations of clinical practices were conducted from February to May 2018 in 8 care units of 2 large tertiary-care hospitals in Montreal (Québec, Canada). RESULTS: We interviewed 13 managers, 4 nurses, 2 physicians, 3 housekeepers, and 2 medical laboratory technologists. We conducted 7 observations by following IPC nurses (n = 3), nurses (n = 2), or patient attendants (n = 2) in their work routines. Barriers to IPC adoption were related to the context of care, workplace environment issues, and communication issues. The main facilitator of the IPC adoption by HCWs was the "development of an IPC culture or safety culture." The "IPC culture" relied upon leadership support by managers committed to IPC, shared belief in the importance of IPC measures to limit healthcare-associated infections (HAIs), collaboration and good communication among staff, as well as proactivity and ownership of IPC measures (ie, development of local solutions to reduce HAIs and "working together" toward common goals). CONCLUSIONS: Adoption of recommended IPC measures by HCWs is strongly influenced by the "IPC culture." The IPC culture was not uniform within hospital and differences in IPC culture were identified between care units.

Reorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU.

OBJECTIVES: To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. DESIGN: A prospective, observational, time-motion study. SETTING: A level 3 PICU. PARTICIPANTS: Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013. INTERVENTIONS: The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare). MEASUREMENTS AND MAIN RESULTS: Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48-72%]) and after (55% [interquartile range, 51-57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30-37%) before to 34.7% (interquartile range, 33-75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23-41%) to 18.6% (interquartile range, 16-22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12-22%) to 26.2% (interquartile range, 23-28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit. CONCLUSIONS: The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies.

A laboratory nanoseismological study on deep-focus earthquake micromechanics.

Global earthquake occurring rate displays an exponential decay down to ~300 km and then peaks around 550 to 600 km before terminating abruptly near 700 km. How fractures initiate, nucleate, and propagate at these depths remains one of the greatest puzzles in earth science, as increasing pressure inhibits fracture propagation. We report nanoseismological analysis on high-resolution acoustic emission (AE) records obtained during ruptures triggered by partial transformation from olivine to spinel in Mg2GeO4, an analog to the dominant mineral (Mg,Fe)2SiO4 olivine in the upper mantle, using state-of-the-art seismological techniques, in the laboratory. AEs' focal mechanisms, as well as their distribution in both space and time during deformation, are carefully analyzed. Microstructure analysis shows that AEs are produced by the dynamic propagation of shear bands consisting of nanograined spinel. These nanoshear bands have a near constant thickness (~100 nm) but varying lengths and self-organize during deformation. This precursory seismic process leads to ultimate macroscopic failure of the samples. Several source parameters of AE events were extracted from the recorded waveforms, allowing close tracking of event initiation, clustering, and propagation throughout the deformation/transformation process. AEs follow the Gutenberg-Richter statistics with a well-defined b value of 1.5 over three orders of moment magnitudes, suggesting that laboratory failure processes are self-affine. The seismic relation between magnitude and rupture area correctly predicts AE magnitude at millimeter scales. A rupture propagation model based on strain localization theory is proposed. Future numerical analyses may help resolve scaling issues between laboratory AE events and deep-focus earthquakes.

Electronic Medical Record in Pediatric Intensive Care: Implementation Process Assessment.

The implementation of an electronic medical record (EMR) is a high-priority project in a majority of industrialized countries. The Healthcare Information and Management Systems Society (HIMSS) Analytics established an eight-stage EMR Adoption Model (EMRAM) to track progress against health care organizations across a country. In Canada, 36.5% of the hospitals are at the stage 3 or higher, whereas 0.2% have reached the seventh stage. To assess the impact on the safety and caregivers' satisfaction of a stage 7 EMR in a Quebec Pediatric Hospital initially at the EMRAM stage 3, a pilot customized implementation of paperless pediatric intensive care EMR was performed and evaluated. Six months after implementation, there was a nonsignificant decrease in severe medical incidents in comparison to the same period of time, the previous year. Most pediatric intensive care unit (PICU) staff were very or completely comfortable with the EMR, but the EMR satisfied 33.9% of all staff (everyday users [internal staff] and occasional user [external staff]) and 41.9% of internal staff only. The information gathered with this pilot EMR implementation using a 20-month preparation period and a continuous monitoring including change management ("living lab approach") after the "go live" helped in the success of the implementation but did not improve significantly caregivers' satisfaction, in the first 6 months of this dramatic change in practice.

Enhanced olivine carbonation within a basalt as compared to single-phase experiments: reevaluating the potential of CO2 mineral sequestration.

Batch experiments were conducted in water at 150 °C and PCO2 = 280 bar on a Mg-rich tholeiitic basalt (9.3 wt % MgO and 12.2 wt % CaO) composed of olivine, Ti-magnetite, plagioclase, and clinopyroxene. After 45 days of reaction, 56 wt % of the initial MgO had reacted with CO2 to form Fe-bearing magnesite, (Mg0.8Fe0.2)CO3, along with minor calcium carbonates. The substantial decrease in olivine content upon carbonation supports the idea that ferroan magnesite formation mainly follows from olivine dissolution. In contrast, in experiments performed under similar run durations and P/T conditions with a San Carlos olivine separate (47.8 wt % MgO) of similar grain size, only 5 wt % of the initial MgO content reacted to form Fe-bearing magnesite. The overall carbonation kinetics of the basalt was enhanced by a factor of ca. 40. This could be explained by differences in the chemical and textural properties of the secondary silica layer that covers reacted olivine grains in both types of sample. Consequently, laboratory data obtained on olivine separates might yield a conservative estimate of the true carbonation potential of olivine-bearing basaltic rocks.

Deep-focus earthquake analogs recorded at high pressure and temperature in the laboratory.

Phase transformations of metastable olivine might trigger deep-focus earthquakes (400 to 700 kilometers) in cold subducting lithosphere. To explore the feasibility of this mechanism, we performed laboratory deformation experiments on germanium olivine (Mg2GeO4) under differential stress at high pressure (P = 2 to 5 gigapascals) and within a narrow temperature range (T = 1000 to 1250 kelvin). We found that fractures nucleate at the onset of the olivine-to-spinel transition. These fractures propagate dynamically (at a nonnegligible fraction of the shear wave velocity) so that intense acoustic emissions are generated. Similar to deep-focus earthquakes, these acoustic emissions arise from pure shear sources and obey the Gutenberg-Richter law without following Omori's law. Microstructural observations prove that dynamic weakening likely involves superplasticity of the nanocrystalline spinel reaction product at seismic strain rates.

Seeking optimal renal replacement therapy delivery in intensive care units.

Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.

Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA).

This study evaluated the response to increasing levels of neurally adjusted ventilatory assist (NAVA), a mode converting electrical activity of the diaphragm (EAdi) into pressure, regulated by a proportionality constant called the NAVA level. Fourteen rabbits were studied during baseline, resistive loading and ramp increases of the NAVA level. EAdi, airway (Paw) and esophageal pressure (Pes), Pes pressure time product (PTPes), breathing pattern, and blood gases were measured. Resistive loading increased PTPes and EAdi. P(a)(CO)(2) increased with high load but not during low load. Increasing NAVA levels increased Paw until a breakpoint where the Paw increase was reduced despite increasing NAVA level. At this breakpoint, Pes, PTPes, EAdi, and P(a)(CO)(2) were similar to baseline. Further increase of the NAVA level reduced Pes, PTPes and EAdi without changes in ventilation. In conclusion, observing the trend in Paw during a ramp increase of the NAVA level allows determination of a level where the inspiratory effort matches unloaded conditions.

Overcoming barriers when implementing evidence at the bedside.

Implementing evidence is the basis for improving the organization of care, with the ultimate goal of achieving optimal patient outcomes. As implementing evidence can be a challenging task due to human and system barriers, we propose an innovative framework to facilitate knowledge translation at the bedside. This model is based on a problem-solving approach that was tested in the field of critical care. This method can be adapted to any healthcare environment as the problems encountered when trying to implement guidelines and protocols are common.

Titration and implementation of neurally adjusted ventilatory assist in critically ill patients.

BACKGROUND: Neurally adjusted ventilatory assist (NAVA) delivers assist in proportion to the patient's respiratory drive as reflected by the diaphragm electrical activity (EAdi). We examined to what extent NAVA can unload inspiratory muscles, and whether unloading is sustainable when implementing a NAVA level identified as adequate (NAVAal) during a titration procedure. METHODS: Fifteen adult, critically ill patients with a Pao(2)/fraction of inspired oxygen (Fio(2)) ratio < 300 mm Hg were studied. NAVAal was identified based on the change from a steep increase to a less steep increase in airway pressure (Paw) and tidal volume (Vt) in response to systematically increasing the NAVA level from low (NAVAlow) to high (NAVAhigh). NAVAal was implemented for 3 h. RESULTS: At NAVAal, the median esophageal pressure time product (PTPes) and EAdi values were reduced by 47% of NAVAlow (quartiles, 16 to 69% of NAVAlow) and 18% of NAVAlow (quartiles, 15 to 26% of NAVAlow), respectively. At NAVAhigh, PTPes and EAdi values were reduced by 74% of NAVAlow (quartiles, 56 to 86% of NAVAlow) and 36% of NAVAlow (quartiles, 21 to 51% of NAVAlow; p < or = 0.005 for all). Parameters during 3 h on NAVAal were not different from parameters during titration at NAVAal, and were as follows: Vt, 5.9 mL/kg predicted body weight (PBW) [quartiles, 5.4 to 7.2 mL/kg PBW]; respiratory rate (RR), 29 breaths/min (quartiles, 22 to 33 breaths/min); mean inspiratory Paw, 16 cm H(2)O (quartiles, 13 to 20 cm H(2)O); PTPes, 45% of NAVAlow (quartiles, 28 to 57% of NAVAlow); and EAdi, 76% of NAVAlow (quartiles, 63 to 89% of NAVAlow). Pao(2)/Fio(2) ratio, Paco(2), and cardiac performance during NAVAal were unchanged, while Paw and Vt were lower, and RR was higher when compared to conventional ventilation before implementing NAVAal. CONCLUSIONS: Systematically increasing the NAVA level reduces respiratory drive, unloads respiratory muscles, and offers a method to determine an assist level that results in sustained unloading, low Vt, and stable cardiopulmonary function when implemented for 3 h.

Appropriateness of diagnosis and orientation of 996 consecutive patients admitted in an emergency department with flow-based organization.

BACKGROUND: Recent data, focused on the inability to transfer emergency patients to inpatient beds, has shown this to be the single most important factor contributing to overcrowding. Our Emergency Department (ED) was reorganized in the year 2000 based on the optimization of patients' flow. In this model, the emergency team had to refer patients to units fitting best to their condition with minimal delays. OBJECTIVES: To evaluate adequacy of both diagnosis between emergency room and hospitalization wards and patients' orientation in the context of an early discharge from the ED. METHODS: We collected data from 996 consecutive nontrauma patients for whom an admission was decided. Duration of stay in the ED and all related parameters were studied. Patients were categorized according to the adequacy of the diagnosis proposed at ED discharge as compared with the final diagnosis at hospital discharge. The patients' orientation appropriateness was also assessed. RESULTS: Despite a median duration of time of 6 h (21 min-54 h) diagnostics made by the emergency physicians and the patients' orientation were considered as adequate in most of the cases (66 and 96%, respectively). Fast track developed with medical intensive care and cardiology intensive care allowed referral of patients requiring these specific units within 2.2 h (27 min-17 h) and 2 h (41 min-8 h), respectively. The ED length of stay was highly influenced by the admission location and by the patient's age. CONCLUSION: A short time of stay in the ED is compatible with both a good diagnosis and a good orientation of ED patients requiring admission for specialized care.