Emergency department staff experiences of working with people who self-harm: A qualitative examination of barriers to optimal care.

For people who seek help for self-harm, emergency departments (ED) are often the first point of contact, making them a suitable setting for intervention. In Australia, base rates of self-harm presentations to ED are increasing, while the quality of care these people receive is often considered sub-optimal. This study used qualitative interviews to explore potential barriers ED staff face in delivering best possible self-harm care. Seventeen staff across two EDs in the state of Victoria, Australia, were interviewed regarding their perceptions of barriers to providing optimal self-harm care and suggestions for improvement. Three themes were identified: (1) system-related challenges when managing self-harm in ED, including the shortage of hospital resources, challenges of ED as a physical environment, and insufficient education, training and guidelines about self-harm care for staff; (2) human-related challenges regarding management of self-harm in ED, which encompassed the nature of a person's circumstances and presentation, and staff attitudes towards self-harm; and (3) staff suggestions for improving self-harm care in ED. Specific recommendations that were proposed based on these findings included introducing a separate ED area for mental health-related presentations, provision of specialised education and training about self-harm care to staff, better implementation of guidelines on treating self-harm in ED, and employing mental health educators to provide on-the-floor mentoring to nurses. The relevance of these barriers and recommendations to the wider healthcare sector is also discussed. Together, these findings may inform improvements to the quality of care provided to those who engage in self-harm.

Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions.

Objectives: Safety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study in pediatric trauma is limited. We hypothesized that MVC patients from low-opportunity neighborhoods are less likely to be appropriately restrained. Methods: A retrospective cross-sectional study was performed on children/adolescents ≤18 years old in MVCs between January 1, 2011 and December 31, 2021. Patients were identified from the Children's Hospital Los Angeles trauma registry. The outcome was safety restraint use (appropriately restrained, not appropriately restrained). COI levels by home zip codes were stratified as very low, low, moderate, high, and very high. Multivariable regression controlling for age identified factors associated with safety restraint use. Results: Of 337 patients, 73.9% were appropriately restrained and 26.1% were not appropriately restrained. Compared with appropriately restrained patients, more not appropriately restrained patients were from low-COI (26.1% vs 20.9%), high-COI (14.8% vs 10.8%) and very high-COI (10.2% vs 3.6%) neighborhoods. Multivariable analysis demonstrated no significant associations in appropriate restraint use and COI. There was a non-significant trend that children/adolescents from moderate-COI neighborhoods were more likely than those from very low-COI neighborhoods to be appropriately restrained (OR=1.82, 95% CI 0.78, 4.28). Conclusion: Injury prevention initiatives focused on safety restraints should target families of children from all neighborhood types. Level of evidence: III.

Post-lockdown burden of road injury involving hospitalisation in Victoria, Australia: A statewide, population-based time series analysis.

OBJECTIVES: Ever since COVID-19, short-term changes in transport injury patterns have been observed. The aim is to examine both the initial and the enduring impact of government lockdown and the pandemic on road injuries requiring hospitalisation and road fatalities. METHODS: Time series analysis of Transport Accident Commission (TAC) claims involving hospitalisation and fatalities in Victoria, Australia, from July 2016 to May 2023, including lockdown (March 2020 to October 2020) and post-lockdown (November 2020 onwards). RESULTS: A total of 46 450 TAC claims were included. Average claims during the pre-pandemic period were 652/month. Lockdown restrictions were associated with a statistically significant fall in monthly claims (-255, 95% confidence interval [CI] = -315 to -194, P < 0.01). This was consistent across road users, days of the week, hours of the day, injury severity, sex and central versus rural locations. The post-lockdown period had a statistically significant reduction in monthly claims to 76% (95% CI = 67-84) of pre-pandemic levels (-158, 95% CI = -213 to -102, P <0.01). This was consistent across all subgroups except bicyclist injuries, which remained constant (-8, 95% CI = -16 to 0, P = 0.05). There was a significant upward trend in the fatality-to-claim ratio post-lockdown (0.001, 95% CI = 0-0.001, P <0.01). CONCLUSION: Road injury requiring hospitalisation decreased significantly during governmental lockdown and has returned to three-quarters of pre-pandemic levels (except bicyclist injuries that have remained constant), but there is an increasingly disproportionate number of fatalities. This represents a new baseline of injury burden for EDs and hospitals that manage trauma patients.

Comparison of clinical outcomes of venous thromboembolic disease between outpatient and inpatient management.

Objectives: To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). Materials and methods: . Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in the Emergency Center of a private hospital in Argentina. Results: There were 1202 cases, 908 with isolated deep vein thrombosis (DVT), 205 with isolated pulmonary embolism (PE), and 89 cases of combined DVT - PE. 66% were women, with a median age of 77 years; 72% of cases were managed on an outpatient basis (n= 862). Comorbidities associated with hospitalization were obesity (p=0.03), chronic obstructive pulmonary disease (COPD) (p=0.01), heart failure (CHF) (p=0.01), chronic renal failure (CKD) (p=0.01), and cancer (p=0.01). At 90 days, the cumulative incidence of bleeding was 2.6% in inpatient compared to 2.9% in outpatient management (p=0.81); recurrence was 0% versus 0.9% (p=0.07), and mortality was 42.9% versus 18.9%, respectively (p=0.01). The HR for 90-day mortality in hospitalized patients adjusted for confounders (sex, age, type of VTE, obesity, CKD, CHF, COPD, and cancer) was 1.99 (95% CI 1.49-2.64; p=0.01). Conclusions: In this elderly, and predominantly female Argentine population, the 90-day mortality in patients hospitalized for VTE was higher than mortality in patients with outpatient management, without differences in recurrence or major bleeding.

Logistic analysis of delayed reporting of emergency blood potassium and comparison of improved outcomes.

Potassium testing is an essential test in emergency medicine. Turnaround time (TAT) is the time between specimen receipt by the laboratory and the release of the test report. A brief in-laboratory TAT increases emergency department effectiveness. Optimizing processes to shorten TAT using other tools requires extensive time, resources, training, and support. Therefore, we aimed to find a convenient way to shorten TAT, identify risk factors affecting the timeliness of emergency potassium test reporting, and verify the intervention's effects. The dependent variable was emergency potassium reporting time > 30 or < 30 min. Logistic analysis was performed on monitorable factors, such as sex, age, potassium results, number of items, specimen processing time (including centrifugation and time before specimen loading), critical value ratio, instrument status, shift where the report was issued, specimen status, and work experience, as independent variables. In the multivariate analysis, work experience, instrument failure rate, and specimen processing time were risk factors for emergency blood potassium reporting exceeding 30 min. Improvement measures were implemented, significantly decreasing the timeout rate for acute potassium reporting. Our study confirms the usefulness of logistics in reducing the time required to report potassium levels in the emergency department, providing a new perspective on quality management.

The impact of COVID-19 on emergency department presentations for mental health disorders in Queensland, Australia: A time series analysis.

BACKGROUND: The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data. METHODS: This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts. RESULTS: Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). CONCLUSIONS: Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.

Frequency and features of medical emergencies at a teaching dental hospital in Saudi Arabia: a 14-year retrospective observational study.

BACKGROUND: This study aimed to determine the nature, frequency, and characteristics of medical emergencies occurring at the King Abdulaziz University Dental Hospital. MATERIALS AND METHODS: The incident reports of medical emergencies recorded at the King Abdulaziz University Dental Hospital from January 2008 to December 2022 were retrospectively reviewed. The annual/overall incidence of medical emergency events was calculated per 100,000 patients. The following characteristics of the patients/events were evaluated: age, gender, operator, procedure, location, timing of treatment, administration of local anesthesia, past medical history, symptoms, diagnosis, outcome, and disposition. Multivariable logistic regression models were used to investigate the associations of these characteristics with two outcomes: syncope and transfer to the emergency room (ER). RESULTS: The incidence of emergency events was 17.4 per 100,000 patients. Syncope and hypoglycemia were the most common emergencies. Most incidents recovered, with only 13% requiring transfer to the ER. Undergoing no procedure and American Society of Anesthesiologists (ASA) class 2,3 were associated with syncope. Undergoing a general dental procedure, ASA class 2,3, and a diagnosis other than hypoglycemia and syncope were associated with transfer to the ER. CONCLUSIONS: The incidence of medical emergencies was low. Dental practitioners need to remain aware of the contributing factors, such as past medical history and anxiety, but medical emergencies can occur in healthy individuals as well. Preparation of the dental office, training of the personnel, and proper recording of the events are essential components of a well-established medical emergency protocol in dental institutions.

[Initial assessment of ENT emergencies-a feasibility study]. / Ersteinschätzung HNO-spezifischer Notfälle ­ eine Machbarkeitsstudie.

In Germany, an increased volume of patient cases in the emergency department has been observed for several years, many of which do not represent hospital emergencies. To improve the triage and management of patient flows, the Structured Initial Medical Assessment (Strukturierte medizinische Ersteinschätzung in Deutschland, SmED) triage system was developed. This certified medical product is intended to assess both the urgency of everyday complaints and their adequate medical care in a targeted, faster, and safer manner. It supports medical professionals in triage by suggesting courses of action, whereby the ultimate responsibility remains with the professionals themselves. For otorhinolaryngology, a content review was carried out with regard to plausibility and patient safety in the head and neck region on the basis of nine specific emergencies. The cases were simulated by nine otorhinolaryngologists and triaged on the basis of the SmED by medical staff and medical students by assigning a care level and timepoint (urgency). The majority of cases were correctly assigned. The SmED initial assessment system is a good tool for assessing urgent clinical pictures in ear, nose, and throat (ENT) medicine. The long-term goal of the initial assessment is to relieve the capacities of outpatient departments. In order to achieve this and to shorten patient waiting times, it would be necessary to refer patients quickly to otorhinolaryngology. It is therefore necessary to ensure that patients are referred to an ENT on-call service via the online tool.

Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study.

BACKGROUND: Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective. METHODS: In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation. DATA ANALYSIS: We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively. RESULTS: Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population. CONCLUSION: Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.

Changing culture: An intervention to improve blood culture quality in the emergency department.

OBJECTIVE: Blood cultures (BCs) remain a key investigation in ED patients at risk of bacteraemia. The aim of this study was to assess the effect of a multi-modal, nursing-led intervention to improve the quality of BCs in the ED, in terms of single culture, underfilling and contamination rates. METHOD: The present study was conducted in the ED of a large urban tertiary referral hospital. The study included four phases: pre-intervention, intervention, post-intervention and sustainability periods. A multi-modal intervention to improve BC quality consisting small group education, posters, brief educational videos, social media presence, quality feedback, small group/individual mentoring and availability of BC collection kits was designed and delivered by two senior ED nurses over 7 weeks. Study data comprised rates of single, underfilled and contaminated cultures in each of three 18-week periods: pre-intervention (baseline), post-intervention and sustainability. RESULTS: Over the study period 4908 BC sets were collected during 2347 episodes of care in the ED. Single culture sets reduced from 56.2% in the pre-intervention period to 22.8% post-intervention (P < 0.01) and 18.8% in the sustainability period (P < 0.01). Underfilled bottle rates were also significantly reduced (aerobic 52.8% pre-intervention to 19.2% post-intervention, 18.8% sustainability, anaerobic 46.8% pre-intervention to 23.3% post-intervention, 23.8% sustainability). Skin contaminants were grown from 3.7% of BC sets in the pre-intervention period, improving to 1.5% in the post-intervention period (P < 0.001) and 2.1% in the sustainability period (P = 0.03). Total volume of blood cultured was significantly associated with diagnosis of bacteraemia. CONCLUSION: Significant improvements in BC quality are possible with nursing-based interventions in the ED.

Provider-to-provider telehealth for sepsis patients in a cohort of rural emergency departments.

BACKGROUND: Telehealth has been proposed as one strategy to improve the quality of time-sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth-supplemented ED (tele-ED) care, health care costs, and clinical outcomes among patients with sepsis in rural EDs. METHODS: Cohort study using Medicare fee-for-service claims data for beneficiaries treated for sepsis in rural EDs between February 1, 2017, and September 30, 2019. Our primary hospital-level analysis used multivariable generalized estimating equations to measure the association between treatment in a tele-ED-capable hospital and 30-day total costs of care. In our supporting secondary analysis, we conducted a propensity-matched analysis of patients who used tele-ED with matched controls from non-tele-ED-capable hospitals. Our primary outcome was total health care payments among index hospitalized patients between the index ED visit and 30 days after hospital discharge, and our secondary outcomes included hospital mortality, hospital length of stay, 90-day mortality, 28-day hospital-free days, and 30-day inpatient readmissions. RESULTS: In our primary analysis, sepsis patients in tele-ED-capable hospitals had 6.7% higher (95% confidence interval [CI] 2.1%-11.5%) total health care costs compared to those in non-tele-ED-capable hospitals. In our propensity-matched patient-level analysis, total health care costs were 23% higher (95% CI 16.5%-30.4%) in tele-ED cases than matched non-tele-ED controls. Clinical outcomes were similar. CONCLUSIONS: Tele-ED capability in a mature rural tele-ED network was not associated with decreased health care costs or improved clinical outcomes. Future work is needed to reduce rural-urban sepsis care disparities and formalize systems of regionalized care.

Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service / Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Resumo Introdução As doenças cardiovasculares (DCV) repre-sentam a principal causa de morte global, destacando-se em internações e gastos. Diante disso, é essencial compreender as principais DCV em pacientes admitidos em serviços de emergência hospitalar e a atuação do fisioterapeuta para planejamento e direcionamento dos serviços de saúde e para denotar a participação e incentivar formações fisioterapêuticas específicas no contexto da atenção terciária. Objetivo Traçar o perfil de emergências cardiovasculares e avaliar a atuação fisioterapêutica em pacientes adultos de serviço de emergência de um hospital no interior do estado de São Paulo. Métodos Trata-se de um estudo observacional, em que foram analisadas 1.256 fichas de passagem de plantão, no período de oito meses. Os dados coletados foram idade, sexo, hipótese diagnóstica cardiovascular e tratamento fisioterapêutico realizado. Resultados Foram incluídos 75 pacientes que apresentavam o perfil de emergências cardiovasculares, sendo as mais prevalentes: insuficiência cardíaca (n = 21), síndrome corona-riana aguda (n = 14), infarto agudo do miocárdio (n = 13), bradarritmia (n = 6) e crise hipertensiva (n = 5). Em relação à atuação fisioterapêutica e suas aplicações, as mais frequentes foram manejo da ventilação mecânica invasiva (n = 34), manobras de reexpansão pulmonar (n = 17), auxílio a intubação orotraqueal (n = 17), ventila-ção mecânica não invasiva (n = 14), manobras de higiene brônquica (n = 12), cinesioterapia (n = 10) e sedestação (n = 10). Conclusão A insuficiência cardíaca e a síndrome coronária aguda foram as doenças cardiovasculares que mais ocasionaram internação no serviço de emergência hospitalar e as condutas com ênfase no aparelho respiratório foram as mais aplicadas.

Evaluation of Dexamethasone Dosing Strategies in Pediatric Asthma Exacerbations.

OBJECTIVES: This study aimed to determine if there is a difference in health care use in pediatric asthma exacerbations with dexamethasone at a standardized dose compared with a weight-based approach.  . METHODS: This was a single-center, retrospective study of patients ages 2 to 17 years presenting to the pediatric emergency department (ED) with an asthma exacerbation between July 1, 2018, and June 30, 2021. Patients who received at least 1 dose of dexamethasone and had an International Classification of Diseases, 10th revision (ICD-10) code for asthma were included. The primary end point was the rate of return visits to the ED within 30 days and 31 to 90 days. Secondary end points included incidence of hospitalization and intubation, length of stay, dexamethasone dosing discrepancies, other corticosteroids or adjunctive therapies used, and medication escalation at discharge. The incidences of vomiting, hyperglycemia, and hypertension were also evaluated. Descriptive statistics were used for categoric variables and a Kaplan-Meier survival curve and Cox regression evaluated the primary outcome. RESULTS: A total of 252 patients were included, 162 in the standardized dosing group and 90 in the weight-based group. There was no difference in return visits at 30 days and 31 to 90 days (3.1 vs 4.4, p = 0.58; and 3.7 vs 7.8, p = 0.16). The standardized group had a statistically significant shorter length of stay and lower ipratropium and magnesium use compared with the weight-based group. However, hospitalization rates were lower overall in the weight-based group. The incidences of vomiting, hyperglycemia, and hypertension were similar. CONCLUSIONS: A standardized dosing strategy for dexamethasone in pediatric asthma exacerbations showed favorable outcomes and may lead to improved adherence.

Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments.

BACKGROUND: Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited. AIM: To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs. METHODS: The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes. RESULTS: A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care. CONCLUSION: Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.

Perceção de satisfação dos utentes relativamente aos cuidados de enfermagem numa urgência médico-cirúrgica / Patients' perceived satisfaction with nursing care in a medical-surgical emergency unit / Percepción de la satisfacción de los usuarios respecto a los cuidados de enfermería en un servicio de urgencias médico-quirúrgicas

Resumo Enquadramento: A avaliação da satisfação dos utentes permite obter indicadores importantes para implementar estratégias promotoras de cuidados de saúde, e como tal, de satisfação. Objetivo: Identificar a perceção de satisfação dos utentes relativamente aos cuidados de enfermagem e, avaliar a sua relação com as variáveis sociodemográficas e profissionais. Metodologia: Estudo transversal analítico, exploratório, de cariz quantitativo, a partir da aplicação da Escala de Satisfação do Cidadão face aos Cuidados de Enfermagem (ESCCE), numa amostra de 100 utentes, numa urgência médico-cirúrgica. Resultados: Obteve-se uma pontuação média de perceção de satisfação de 217 ± 57,8. Constatou-se ainda que 41,8% da amostra, apresentou uma perceção elevada de satisfação, 23,2% moderada e 35,3% de baixa satisfação. Verificou-se uma relação estatística significativa com a variável habilitações literárias: os respondentes com menor nível de habilitação, apresentaram uma perceção de satisfação mais elevada (239 ± 60,8). Conclusão: Os resultados sugerem a pertinência em formação de competências técnica, relacional e comunicacional, como estratégias promotoras dos cuidados, e de satisfação, ao nível individual e institucional relativamente aos cuidados de enfermagem.

Abstract Background: Assessing patient satisfaction allows obtaining relevant indicators to implement strategies for improving the quality of care and, consequently, patient satisfaction. Objective: To identify patients' perceived satisfaction with nursing care and assess its association with sociodemographic and professional variables. Methodology: Analytical, cross-sectional, and exploratory study with a quantitative approach. The Escala de Satisfação do Cidadão face aos Cuidados de Enfermagem (Citizen Satisfaction with Nursing Care Scale) was applied to a sample of 100 patients in a medical-surgical emergency unit. Results: The mean perceived satisfaction was 217 ± 57.8. In this sample, 41.8% of participants had high perceived satisfaction, 23.2% had moderate perceived satisfaction, and 35.3% had low perceived satisfaction. A statistically significant correlation was found between satisfaction and education level: participants with lower education levels had higher perceived satisfaction (239 ± 60.8). Conclusion: Technical, relational, and communication skills training is important to improve the quality of care and increase satisfaction with nursing care at an individual and institutional level.

Resumen Marco contextual: La evaluación de la satisfacción de los usuarios permite obtener indicadores importantes para poner en marcha estrategias que promuevan la atención sanitaria y, con ello, la satisfacción. Objetivo: Identificar la percepción de la satisfacción de los usuarios con respecto a los cuidados de enfermería y evaluar su relación con las variables sociodemográficas y profesionales. Metodología: Estudio transversal, analítico, exploratorio y cuantitativo basado en la aplicación de la Escala de Satisfacción del Ciudadano frente a los Cuidados de Enfermería (ESCCE) en una muestra de 100 usuarios de un servicio de urgencias médico-quirúrgicas. Resultados: Se obtuvo una puntuación media de satisfacción percibida de 217 ± 57,8. También se observó que el 41,8% de la muestra tenía una percepción de satisfacción elevada, el 23,2% una satisfacción moderada y el 35,3% una satisfacción baja. Se encontró una relación estadísticamente significativa con la variable nivel de estudios: los encuestados con menor nivel de estudios tenían una mayor percepción de satisfacción (239 ± 60,8). Conclusión: Los resultados sugieren que es relevante la formación en competencias técnicas, relacionales y de comunicación, como estrategias para promover el cuidado y la satisfacción, a nivel individual e institucional, respecto a los cuidados de enfermería.

Burnout em enfermeiros do serviço de urgência médico-cirúrgica após a pandemia COVID-19 / Medical-surgical emergency nurses' burnout after the COVID-19 pandemic / Burnout en enfermeros del servicio de urgencias médico-quirúrgicas tras la pandemia de COVID-19

Resumo Enquadramento: O burnout consiste numa síndrome de índole tridimensional, decorrente do exercício de uma atividade profissional. Objetivos: Identificar o nível de burnout percecionado pelos enfermeiros do serviço de urgência médico-cirúrgica, após a pandemia COVID-19. Analisar a relação entre as pontuações médias das dimensões do burnout e as variáveis sociodemográficas e profissionais. Metodologia: Estudo quantitativo, descritivo-correlacional, num plano transversal, envolvendo uma amostra de 39 enfermeiros. Resultados: A maioria da amostra (51,3%) enquadra-se no nível sem burnout/burnout reduzido, 28,2% no burnout moderado e 20,5% no burnout elevado. No que concerne à pontuação média por dimensão, a mais elevada surge na exaustão emocional, com 2,60 ± 1,35. Constatou-se uma relação estatisticamente significativa em algumas dimensões, como: o sexo, as horas de trabalho diárias, a satisfação no local de trabalho e a perceção do aumento da exaustão decorrente da pandemia. Conclusão: As percentagens de burnout moderado e burnout elevado relevam a importância da sua monitorização contínua, visando o planeamento/promoção de estratégias de intervenção combativas adequadas, bem como a sua prevenção.

Abstract Background: Burnout is a tridimensional syndrome resulting from professional activities. Objectives: To identify the level of burnout perceived by medical-surgical emergency nurses after the COVID-19 pandemic and to analyze the relationship between the mean scores of the burnout dimensions and the sociodemographic and professional variables. Methodology: Quantitative, descriptive-correlational, and cross-sectional study on a sample of 39 nurses. Results: Most participants (51.3%) have no burnout or a low burnout level, 28.2% have a moderate burnout level, and 20.5% have a high burnout level. Regarding the mean score per dimension, the highest score was emotional exhaustion, with 2.60 ± 1.35. A statistically significant relationship was found in some dimensions, such as gender, working hours per day, workplace satisfaction, and perception of increased fatigue/exhaustion due to the pandemic. Conclusion: The percentages of moderate and high burnout highlight the importance of continuous monitoring, aiming at planning and promoting appropriate prevention and intervention strategies.

Resumen Marco contextual: El burnout consiste en un síndrome tridimensional derivado del ejercicio de una actividad profesional. Objetivos: Identificar el nivel de burnout percibido por los enfermeros del servicio de urgencias médico-quirúrgicas tras la pandemia de COVID-19. Analizar la relación entre las puntuaciones medias de las dimensiones del burnout y las variables sociodemográficas y profesionales. Metodología: Estudio cuantitativo, descriptivo-correlacional, en un plano transversal, con una muestra de 39 enfermeros. Resultados: La mayoría de la muestra (51,3%) se encuentra en el nivel de sin burnout/burnout reducido, el 28,2% en el de burnout moderado y el 20,5% en el de burnout alto. En cuanto a la puntuación media por dimensión, la más alta se registró en el agotamiento emocional, con 2,60 ± 1,35. Se observó una relación estadísticamente significativa en algunas dimensiones, como el sexo, las horas de trabajo diarias, la satisfacción en el lugar de trabajo y la percepción de un aumento del agotamiento debido a la pandemia. Conclusión: Los porcentajes de burnout moderado y burnout alto ponen de manifiesto la importancia de su seguimiento continuo, con el fin de planificar/promover estrategias adecuadas de intervención para combatirlo, así como para prevenirlo.

Misdiagnosis of Acute Appendicitis in the Emergency Department: Prevalence, Associated Factors, and Outcomes According to the Patients' Disposition.

Background: Although abdominal pain is one of the most common complaints of patients presenting to the emergency department (ED), and acute appendicitis is a leading surgical differential diagnosis of patients presenting with abdominal pain, the diagnosis of acute appendicitis remains challenging. We examined the missed diagnosis rate of acute appendicitis in one ED and evaluated the association between disposition (discharge home or hospitalization in the wrong department) and complicated appendicitis. Methods: We retrospectively evaluated the medical records of patients with acute appendicitis and periappendicular abscess from January 1, 2013, to December 31, 2016. Results: The diagnosis of acute appendicitis was missed in 7.1% of patients (90/1,268) at their first ED encounter: 44 were discharged, and 47 were hospitalized with a wrong diagnosis (1 female patient was both discharged and then hospitalized with an incorrect diagnosis). Compared to the patients who were correctly diagnosed, patients with a missed diagnosis were older (median age 29 years vs 23 years, P=0.022), their time between ED first encounter and surgery was longer (median 29.5 hours vs 9.3 hours, P<0.001), and their rate of complicated appendicitis was higher (54.4% vs 27.5%, P<0.001). Missed females were more commonly hospitalized (26/39), while missed males were more commonly discharged from the ED (31/52) (P=0.019). No differences in the time between the first ED encounter and surgery (29.6 hours vs 29.6 hours, P=0.29) and the rate of complicated appendicitis (63.8% vs 43.2%, P=0.06) were noted between hospitalized patients with a wrong diagnosis and those discharged from the ED. Of the 25 patients with periappendicular abscesses, only 3 could be related to missed diagnoses during their first encounter in the ED. Conclusion: We found that 7.1% of patients were missed during their first encounter in the ED. Hospitalization in departments other than general surgery was not protective against delay in surgery or the development of complicated appendicitis. Periappendicular abscess was attributable to late referral rather than a missed diagnosis in most patients.