Patients who leave the Emergency Department without being seen. Has COVID-19 affected this phenomenon?

BACKGROUND AND AIM: Patients who present to an Emergency Department (ED) and leave without being seen by a physician represent a safety concern because they may become severely ill and experience adverse events as a result of lacking or delayed ED treatment. Prior to the COVID-19 outbreak, the increasing number of patients accessing care through the ED in Italy and throughout the world has had implications for health policies. METHODS: A retrospective cohort study that included all ED visits from 1st January 2013 to 31st December 2018 in the Perugia University Hospital has been carried out. RESULTS: During the 5 years investigated 26,344 out of 300,372 (8.77%) patients who attended the ED left the triage area before being seen with an average of 439 patients per month. The same phenomenon has been analysed from February to October 2020. During these 9 months there were a total of 1,824 out of 30,990 (5.88%) patients who left the ED without being seen with an average of 202 per month. The latter value is one third lower than the one related to the period investigated prior to the COVID-19 outbreak. CONCLUSIONS: Such investigation could help to differentiate actual essential demand from non-essential demand within the ED, which could inform quality-improvement policies. Several strategies could be implemented to lower the proportion of patients who leave the department without being seen. Reorganising the activities in the ED with different paths should be implemented with the aim of reducing waiting times and in turn patients' satisfaction.

The effect of prenatal exposure to music on fetal movements and fetal heart rate: a pilot study.

OBJECTIVE: To assess and compare fetal cardiac parameters of fetuses listening to music before and during nonstress test, only during the test or never. STUDY DESIGN: Thirty healthy mother-fetus dyads were randomized in a 1:1:1 ratio to one of three groups: group A in which fetuses were submitted to prelistening phase (33rd + 0 to 36th + 3 week) and listening sessions during 4 nonstress tests, group B in which fetuses were submitted to listening sessions during 4 nonstress tests, and group C receiving 4 nonstress tests without any listening. We assessed mean fetal heart rate, fetal heart rate accelerations, fetal heart rate decelerations, fetal movements and uterine contractility. RESULTS: Fetuses of the group A, who had already listened to a particular piece of music during previous sessions, had significantly increased their heart rate accelerations and movements during the music listening session of the last nonstress test. No significant changes were observed in the number of uterine contractions. CONCLUSIONS: Our findings show that fetuses slightly respond to that music they know, but they do not significantly respond to unknown music.

Violence towards Emergency Nurses: The 2016 Italian National Survey-A cross-sectional study.

AIM: To analyse the dimensions and characteristics of violence towards Emergency nurses in a national context (Italy). BACKGROUND: Nurses are the most exposed to workplace violence, especially in Emergency Department contexts. METHODS: A cross-sectional study was conducted in all Italian regions. Descriptive analyses were used to examine violence from patients and relatives (Type II violence) concerning personal characteristics of the Emergency nurses and perpetrators, environmental and organisational factors. Multinomial logistic regression analysis was used to investigate risk factors. RESULTS: About 76.0% of Emergency nurses experienced verbal violence, 15.5% both verbal and physical violence and only 8.5% denied having experienced either. Older age and more experience in Emergency settings are protective factors. Working in the South of Italy significantly increases the probability of being exposed. DISCUSSION: There are many factors explaining violence, but some correlations are not clear. CONCLUSION: Factors that have a positive effect on this problem include: specific training for younger nurses, a strong alliance between users and health personnel to restore a relationship of trust between parties, physical barriers and appropriate architectural measures. IMPLICATIONS FOR NURSING MANAGEMENT: Comprehensive approaches can represent an effective strategy to counteract workplace violence.

Violence towards Emergency Nurses. The Italian National Survey 2016: A qualitative study.

INTRODUCTION: Physical and verbal aggression against health professionals, particularly nurses, is globally serious and widespread, with the most vulnerable being nurses working in the Accident and Emergency Department. Most international research into this issue focused on quantifying aggression, describing its nature, identifying perpetrators, stratifying risk and implementing preventive or mitigating interventions. Few studies investigated the nurses' subjective perceptions. As part of the 2016 Italian National Survey on Violence against Accident and Emergency Nurses, our research team collected qualitative data to explore their perceptions of Workplace Violence. METHODS: From 19th July 2016 to 19th March 2017 we distributed online a 39-item validated questionnaire to 15,618 Emergency Nurses working in 668 Italian National Health Service Accident and Emergency Departments in all 20 Italian Regions. Answers were analysed using van Kaan's method. RESULTS: 1100 Emergency Nurses responded to the survey and 265 replied to our focus question. There were 144 Females, 119 Males, 2 not stated, average age 42 ±â€¯9 years, average work experience 18 ±â€¯9 years, average Accident and Emergency Department experience 11 ±â€¯8 years. Four major themes emerged: the nurses' perception of physical and verbal aggression, precipitating factors, consequences, and solutions. DISCUSSION: These themes confirmed previous findings and showed that Italian nursing staff's perceptions of physical and verbal aggression is the same as emergency nurses working worldwide. CONCLUSION: How Italian Accident and Emergency nurses perceive Workplace Violence adds to our knowledge of the issue and contributes to finding shared solutions.

Violence towards emergency nurses: A narrative review of theories and frameworks.

INTRODUCTION: Workplace Violence in the health environment is a growing issue worldwide. Emergency department have been identified asa high-risk setting for Workplace Violence and emergency nurses are most exposed to this phenomenon. To address workplace violence in the ED effectively, it is critical to understand frameworks established in the literature to assist in development of appropriate interventions and corrective measures. An overview of available theories of violence towards emergency nurses in the literature is presented herein in the format of a narrative review. METHODS: A search of international literature on WPV theories was conducted in three databases: PubMed, CINAHL, Scopus, and Proquest Central. Articles concerning theories that have direct implications for patient-related violence (client-on-worker Type 2 Violence) in the emergency department were sought. RESULTS: Four hundred and fifty-nine articles were found. Applying established inclusion and exclusion criteria, fourteen of these were included in the review. In the international literature there are 24 theories and frameworks pertaining to violence towards nurses in the emergency department which describe different intervention strategies based on these. DISCUSSION: Both the theories on violence developed by nurses and those derived from other disciplines are complex and many key elements are invariably intertwined. Understanding such theories might be useful to manage violence towards emergency nurses with greater effectiveness.

Interventions to reduce the risk of violence toward emergency department staff: current approaches.

INTRODUCTION: The phenomenon of workplace violence in health care settings, and especially in the emergency department (ED), has assumed the dimensions of a real epidemic. Many studies highlight the need for methods to ensure the safety of staff and propose interventions to address the problem. AIM: The aim of this review was to propose a narrative of the current approaches to reduce workplace violence in the ED, with a particular focus on evaluating the effectiveness of emergency response programs. METHODS: A search was conducted between December 1, 2015 and December 7, 2015, in PubMed and CINAHL. Ten intervention studies were selected and analyzed. RESULTS: Seven of these interventions were based on sectoral interventions and three on comprehensive actions. CONCLUSION: The studies that have attempted to evaluate the effectiveness of interventions have shown weak evidence to date. Further research is needed to identify effective actions to promote a safe work environment in the ED.

Violence against nurses in the triage area: An Italian qualitative study.

AIM: This qualitative study aims to investigate the feelings experienced by nurses following episodes of violence in the workplace. BACKGROUND: Numerous studies show that healthcare professionals are increasingly finding themselves victims of violence; of all professionals, nurses in the Emergency Department and especially those performing triage are one of the staff categories which most frequently experience these episodes during their work. INTRODUCTION: In Italy, this phenomenon has been studied very little in comparison to other countries but has recently been gaining increasing attention. Few studies have investigated the feelings experienced by nurses following episodes of violence in the workplace. METHODS: For this study a phenomenological approach was used. Assumptions and previous findings were set aside (bracketing). A purposive sample of 9 nurses coming from 7 different Emergency Department in the region of Tuscany, Italy was interviewed during a focus group meeting. The data analysis was carried out using the Colaizzi method. RESULTS: Data analysis revealed 10 significant themes/responses. The quality of reporting was guaranteed by adopting the COREQ criteria. DISCUSSION: Data analysis revealed that nurses feel that violent episodes are "inevitable" and that they feel they have grown accustomed to high levels of violence, that they suffer feelings of "inadequacy" but also that they are aware that they themselves can trigger conflict with patients, and again suffer the feeling of "being alone" in facing these problems and a sense of "being left on their own" by the institution and feeling "hurt", "scared", "angry" and have a sense that "it is not fair". Last but not least, "the gender difference" appears to play an important role in the emotional response. CONCLUSIONS: To suffer episodes of violence has serious and severe "hidden costs" which are just as important as the direct, tangible costs.