Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy.

BACKGROUND: Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This retrospective cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called "Diagnostic Anticipation" (DA), which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. METHODS: In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the DA protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. A retrospective cohort study on DA impact was conducted. Using ED electronic data, LOS independent predictors (age, sex, NEDOCS and Priority Color Code, imaging tests, specialistic consultations, hospital admission) were evaluated through multiple regression. RESULTS: During the weeks when DA was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 min for chest pain, but longer by 15.7 min for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority, specialist consultations, imaging test, hospitalization and ED crowding, the difference in visit time was significant for chest pain only (p < 0.001). CONCLUSIONS: The impact of DA varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status.

Relato de caso de tratamento endovascular de fístula aorto-entérica secundária / A case report of an endovascular treatment of secondary aortenteric fistula

O tratamento tradicional da fístula aorto-entérica secundária baseia-se na retirada cirúrgica da prótese, desbridamento aórtico, enxerto extra-anatômico, ou in situ, nos casos em que o campo cirúrgico apresenta-se sem sinais de infecção. Recentemente, alguns autores vêm preconizando o tratamento endovascular em pacientes instáveis e com alto risco cirúrgico. Apresentamos um relato de caso de paciente portador de fístula aorto-entérica secundária tratado inicialmente por via endovascular.

Traditional treatment of secondary aortoenteric fistula is based on open surgery followed by device removal, aortic debridement and extra-anatomic or in situ by-pass when no signs of local infection are found. Recently, some authors have been advocating endovascular treatment in unstable and high-risk patients. We present a case report of a patient who underwent initial endovascular treatment of a secondary aortoenteric fistula.

Getting results for hematology patients through access to the electronic health record.

PURPOSE: To conduct a needs assessment to identify patient and provider perceptions about providing patients with access to their electronic health record in order to develop an online system that is appropriate for all stakeholders. METHODS: Malignant hematology patients were surveyed and health care providers were interviewed to identify issues and validate concerns reported in the literature. Based on the analysed data, a prototype will be designed to examine the feasibility and efficacy of providing patients with access to their electronic health record and tailored information. RESULTS: 61% of patients reported using the internet to find health information; 89% were interested in accessing their electronic health record and 79% stated they would benefit from educational material along with the results. Staff members viewed patient online access to the record favourably, but expressed the importance of providing the necessary patient support and education. A Web-based prototype was developed for patients to review their registration data and blood results. CONCLUSIONS: Hematology oncology patients are more interested in using the internet to monitor their clinical information than to find health information. Using the constructed prototype, the feasibility of this project is currently being tested.

Programmes et services

Il presente les programmes et les services de santé provinciaux du ministére de la santé et des services sociaux du Québec: aide financière accordée aux parents de triplés et de quadruplés, cours prénatals destinés aux parents, groupes de médecine de famille (GMF) - fonctionnement et inscription, indemnisation des victimes d'immunisation (vaccin), aide alimentaire aux femmes enceintes (fondation OLO), dépistage de maladies métaboliques héréditaires, soutien aux organismes communautaires du Ministère de la santé et des services sociaux, dépistage prénatal, dépistage sanguin au talon des nouveau-nés, rôle et pouvoirs des sages-femmes.

Açöes de enfermagem em hemocultura / Nursing actions at blood cutures

A hemocultura é um exame de importância singular em suspeitas clínicas de bacteremia, pois seu resultado possibilita a identificaçäo do agente etiológico e contribui para a determinaçäo da conduta terapêutica específica. Assim, realizou-se este estudo objetivando avaliar como os enfermeiros, técnicos e auxiliares de enfermagem realizavam a coleta de sangue para hemocultura. Os dados foram obtidos através de observaçäo direta e entrevista estruturada individual com 12(42,86 por cento) funcionários da enfermagem que trabalhavam nas unidades de internaçäo de clínica médica de um hospital de ensino, público e geral do interior paulista. Os resultados evidenciaram que diversas condutas säo adotadas no que se refere a anti-sépticos, volume de sangue coletado, coleta em picofebril, uso de máscaras e luvas, lavagem de mäos, dentre outros. É bastante preocupante esta questäo, uma vez que estes aspectos podem interferir no resultado da hemocultura.