Impact of Geriatric Admissions on Workload in the Emergency Department.

Background: Due to the increase in life expectancy, both the general population and the population of patients of emergency departments (ED) are getting older. An understanding of differences, workload and resource requirements may be helpful in improving patient care. The main goal of this study was to evaluate the reasons for geriatric admissions in the ED, identify typical medical problems and assess the number of resources in order to provide more effective management. Methods: We examined 35,720 elderly patients' ED visits over the course of 3 years. The data collected included age, sex, timing and length of stay (LOS), use of various resources, endpoint (admission, discharge or death) and ICD-10 diagnoses. Results: The median age was 73 years [66-81], with more females (54.86%). There were 57.66% elderly (G1), 36.44% senile (G2) and 5.89% long-liver (G3) patients. There were more females in the older groups. The total admission rate was 37.89% (34.19% for G1, 42.21% for G2 and 47.33% for G3). The average length of the patient's stay was 150 min [81-245] (G3 180 min [108-277], G2 (162 min [92-261]) and G1 139 min [71-230]). Heart failure, atrial fibrillation and hip fracture were the most common diagnoses. Nonspecific diagnoses were common in all groups. Conclusion: The vast majority of geriatric patients required considerable resources. With increasing ages, the number of women, LOS and number of admissions increased.

Dignity in the care of people with advanced illness in emergency services from the perspective of family members: A qualitative study.

BACKGROUND AND AIM: Patients with advanced illness frequently attend emergency services, accompanied by their relatives. The objective of this study was to explore and describe the experiences of relatives, related to loss and preservation of dignity in end-of-life care in the emergency department. MATERIALS AND METHODS: Descriptive qualitative study. Eighteen in-depth interviews were conducted in the period between January 2020 and June 2020. The Atlas.Ti ® version 9 programme was used as support in the analysis of the speeches. RESULTS: 3 themes emerged: 1) "the urgency of dignity" which includes aspects related to going to the emergency room and moments when dignity can be threatened; 2) "dignity in the hands of health professionals" which deals with attitudes and gaps in communication skills of professionals: 3) "care from the perspective of dignity in emergencies" which includes conditions that can help preserve dignity and those aspects of the health system that interfere in the maintenance of dignity. CONCLUSION: The care of these patients and their families requires specific protocols that include a humane and dignified approach, as well as intervention programmes aimed at health professionals.

Workplace violence among nursing professionals.

INTRODUCTION: The frequency of workplace violence has increased significantly across several countries, with short- and long-term effects on workers' health. Within the health care sector, nursing professionals are the most exposed to workplace violence, since they provide direct assistance to patients on a 24-hour basis. OBJECTIVES: To identify the types of occupational violence experienced by nursing professionals. METHODS: This was a descriptive, quantitative study of 55 nursing professionals in the emergency unit of a public hospital. Data were collected between April and June 2018 through the Questionnaire for Workplace Violence Experienced or Witnessed by Nursing Professionals. Categorical variables were presented as frequencies and percentages, while continuous variables were described using measures of central tendency and dispersion. RESULTS: A total of 49 (88.9%) participants had experienced workplace violence, with 21 (38%) suffering verbal abuse; 14 (25.4%) experiencing mobbing; 6 (11%) reporting physical violence; 5 (9.1%) suffering sexual harassment; and 3 (5.4%) reporting racial discrimination. Furthermore, 44 (90%) of these individuals reported that the incidents of violence could have been prevented. CONCLUSIONS: The types of violence observed included physical aggression, verbal abuse, sexual harassment and racial discrimination, with verbal abuse being the most commonly reported. These acts were perpetrated by patients and their families, as well as colleagues and supervisors. Violence prevention strategies should be implemented in institutions in order to provide a safe working environment.

Epidemiology and Characteristics of People with Injury Due to Volatile Substance Use to Induce Euphoria.

BACKGROUND: Unhealthy substance use is a public health challenge. Much of the focus of interventions is upon narcotics, stimulants, hallucinogens, central nervous system depressants, and alcohol. However, inhalants are also commonly used in an unhealthy manner and are under-recognized. The purpose of this study is to describe incident emergency department visits for volatile substance use to induce euphoria (VSUIE) injuries in the U.S. Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2015 to 2018. Descriptive frequencies, bivariate analyses using Rao-Scott Chi-Square, and multivariable logistic regression analyses were conducted to describe and examine the association between ED visits and VSUIE. Results: The estimated (weighted) number of VSUIE ED visits during 2015-2018 was 13,130 (95% Confidence Interval, CI: 8,383-17876; Coefficient of variation, CV = 0.18) and accounted for 0.02% of all ED visits. Males were more likely than females (p < .0001), and young adults (ages ≥18 to ≤ 35 years) were more likely than older adults to have a VSUIE ED visit (p <.0001). Conclusion: VSUIE ED visits occur more commonly in young adults than older adults and adolescents. The widespread use of volatile substances to induce euphoria is an under-reported public health issue with life-threatening consequences. Use of volatile substances by adolescents is a particular concern which needs attention and interventions to prevent its initiation.

Análise da ocorrências de quedas em pacientes admitidos em unidades de cuidados críticos / Analysis of the occurrence of falls in patients admitted to critical care units

A queda é um dos eventos adversos mais frequentes na atenção terciária e sua ocorrência ocasiona danos às vezes irreversíveis ao paciente e ônus para seus familiares, instituições e profissionais de saúde. Para pacientes inseridos em unidades de cuidados críticos como centro cirúrgico, pronto socorro e unidade de terapia intensiva, dados sobre o evento queda, condutas após a mesma, complicações e desfechos intra-hospitalares ainda não estão consolidados para uma prática clínica diretiva e segura. Este estudo teve por objetivo analisar as ocorrências de quedas em pacientes adultos admitidos em unidades de cuidados críticos. Trata-se de estudo quantitativo, descritivo realizado em cinco hospitais gerais e de grande porte do município de Belo Horizonte. A coleta ocorreu por meio de consulta a 117 prontuários de pacientes adultos que sofreram quedas em unidades de cuidados críticos e cujo evento foi notificado ao Núcleo de Segurança do Paciente das instituições de abril de 2013 a dezembro de 2019. Foram investigados os dados sociodemográficos e clínicos, os relacionados ao evento queda, as complicações e os desfechos intra-hospitalares. As variáveis foram descritas por meio de frequência, porcentagens e medidas de tendência central. Predominou o sexo masculino (59,83%), que vive sem companheiro (35,04%) e na faixa etária de 60 anos ou mais (54,70%). As causas externas (25,64%), a hipertensão arterial sistêmica (47,00%) e o etilismo (23,08%) foram as características clínicas mais frequentes. As quedas foram mais frequentes no período da madrugada (27,35%), no Pronto Socorro (76,07%) e na maioria dos pacientes que estavam acomodados em maca (36,75%) ou na cama/leito (29,91%). Quanto ao grau de dano no momento da queda, predominou a categoria 'nenhum dano' (43,59%). Quase a metade dos pacientes (47,86%) não foi avaliada quanto a predição de quedas na admissão e 47,01% foi submetida à essa avaliação no dia do evento. A Morse Fall Scale foi aplicada em 26,50% destes pacientes. Quanto aos fatores de risco, 47,86% apresentavam agitação psicomotora/confusão mental e 16,24% alterações cognitivas, 18,80% estavam sob contenção química e 11,11% com contenção física dos membros superiores. Após a queda, o exame de imagem mais indicado foi a tomografia de crânio (19,06%). As complicações mais frequentes advindas da queda foram ferimentos corto-contusos (13,68%), escoriações (10,26%) e trauma cranioencefálico leve (9,40%). Mais da metade recebeu alta (52,14%) e 4,27% evoluíram a óbito por consequência da queda. Concluiu-se que as quedas ocorrem em pacientes admitidos em unidades de cuidados críticos e foram mais frequentes em pronto socorro e em pessoas idosas. O uso de escalas de predição é pouco frequente na admissão dos pacientes. Observou-se a necessidade de propedêutica adicional após a queda e o desfecho relacionado à queda é, por vezes, irreversível. É notória a necessidade de repensar a prática e buscar melhores estratégias quanto a prevenção de quedas visando uma assistência mais qualificada e segura para pacientes criticamente enfermos.

Falls are one of the most frequent adverse events in tertiary care and their occurrence causes sometimes irreversible damage to patients and burdens to their families, institutions and health professionals. For patients admitted to critical care units such as the operating room, emergency room and intensive care unit, data on falls, post-fall management, complications and in-hospital outcomes are not yet consolidated for a directive and safe clinical practice. This study aimed to analyze the occurrence of falls in adult patients admitted to critical care units. This is a quantitative and descriptive study carried out in five general and large hospitals in Belo Horizonte. The collection occurred through consultation of 117 medical records of adult patients who suffered falls in critical care units and whose event was reported to the Center for Patient Safety of the institutions from April 2013 to December 2019. Sociodemographic and clinical data, data related to the fall event, complications and in-hospital outcomes were investigated. The variables were described by means of frequency, percentages and measures of central tendency. There was a predominance of males (59.83%), living without a partner (35.04%) and in the age group of 60 years or older (54.70%). External causes (25.64%), hypertension (47.00%) and alcoholism (23.08%) were the most frequent clinical characteristics. Falls were more frequent in the early morning period (27.35%), in the Emergency Room (76.07%) and most patients were accommodated on a stretcher (36.75%) or in bed/bed (29.91%). As for the degree of injury at the time of the fall, the 'no injury' category predominated (43.59%). Almost half of the patients (47.86%) were not assessed for fall prediction on admission and 47.01% underwent assessment on the day of the event. The Morse Fall Scale was applied in 26.50% of these patients. As for risk factors, 47.86% had psychomotor agitation/acute confusions and 16.24% cognitive alterations, 18.80% were under chemical restraint and 11.11% with physical restraint of the upper limbs. After the fall, the most indicated imaging exam was the skull tomography (19.06%). The most frequent complications from a fall were blunt force injuries (13.68%), abrasions (10.26%), and mild traumatic brain injury (9.40%). More than half were discharged (52.14%) and 4.27% died as a result of the fall. Falls were more frequent in emergency rooms and in elderly people. The use of prediction scales is not frequent in the admission of patients. It was observed the need for additional propedeutics after a fall and the fall-related outcome is sometimes irreversible. It is notorious the need to rethink the practice and seek better strategies for fall prevention aiming at a more qualified and safer care for critically ill patients.

The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review.

BACKGROUND: In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked. OBJECTIVE: To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. DESIGN: Review of qualitative and quantitative studies within a data-based convergent synthesis design. DATA SOURCES: A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists. REVIEW METHODS: The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes. RESULTS: In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality. CONCLUSIONS: This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.

Investigation of Japan Disaster Medical Assistance Team response guidelines assuming catastrophic damage from a Nankai Trough earthquake.

Aim: Transporting critically ill patients outside of disaster-affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake. Methods: Japan was divided into three areas based on the level of predicted damage (definitely, possibly, and non-affected areas). A survey of DMATs and the locations of emergency base hospitals and intensive care units (ICUs) in each area was carried out, and the ability to support disaster areas was investigated. Next, a survey of wide-area medical transport by Self-Defense Force aircraft and the medical transport abilities of helicopter ambulances was carried out. The numbers of ICU beds in each area were compared, and the capacity to accept patients was investigated. Finally, subjects for further study were examined. Results: The number of DMATs that could be sent from non-affected areas was insufficient. The number of patients that can be transported by Self-Defense Force aircraft and helicopter ambulance during the first 3 days was determined to be 1,443. The number of patients that can be accepted by ICUs in non-affected areas was insufficient. A system needs to be developed to provide medical treatment for critically ill patients within disaster areas during the acute phase. This will require DMAT operational reforms and the creation of logistics systems such as the supply of resources for earthquake-reinforced hospitals. Conclusion: In addition to patient transport, systems to provide medical care inside disaster-affected areas are needed.

Teamwork improvement in emergency trauma departments.

BACKGROUND: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. MATERIALS AND METHODS: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. RESULTS: Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals. CONCLUSIONS: Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork.

A novel prediction model for all cause emergency department visits in ischemic heart disease.

BACKGROUND: Ischemic heart disease (IHD) is the main cause of morbidity and mortality worldwide, and a considerable part of these patients attend to emergency departments, which increases the burden to these busy departments. The aim of this study was to develop a prediction model enabling prediction of all cause emergency department (ED) visits in patients with documented coronary stenosis in a derivation set, and then to determine its accuracy in a validation set. METHODS: In a prospective study at outpatient setting of Baqiyatallah hospital, Tehran, Iran, 502 patients with IHD were followed for 6 months for observing the outcome of ED visits for all causes. They were divided in two random groups of derivation set (n = 335) and validation set (n = 167). In the derivation set, to achieve an all cause ED visits prediction model, a prediction model was reached by entering demographic data, clinical variables, somatic comorbidity (Ifudu index), level of anxiety and depression (Hospital Anxiety Depression Scale (HADS) questionnaire), and angina grade (WHO Rose Angina) to a logistic regression. Then in the validation set, the sensitivity, specificity, and the accuracy of that model was tested. RESULTS: A novel model for prediction of all cause ED visits in IHD patients in six months was presented with gender, anxiety, WHO angina grade and somatic comorbidity as inputs. Sensitivity, specificity, and accuracy of the model were 63.0%, 68.6%, and 67.7%, respectively. CONCLUSIONS: Testing and using the achieved model is suggested to health care providers in other settings.