Patient safety in emergency departments: a problem for health care systems? An international survey.

BACKGROUND AND IMPORTANCE: Patient safety in healthcare is one of the cornerstones of quality of care. The emergency department (ED) is by its very nature a place where errors and safety issues are liable to occur. OBJECTIVE: The aim of the study was to assess health professionals' perception of the level of safety in EDs and to identify in which work domains safety appears most at risk. DESIGN AND PARTICIPANTS: Between 30 January and 27 February 2023, a survey addressing the main domains of safety was distributed to ED health care professionals through the European Society of Emergency Medicine contact network. It addressed five main domains: teamwork, safety leadership, physical environment and equipment, staff/external teams, and organisational factors and informatics, with a number of items for each domain. Further questions about infection control and team morale were added. The Cronbach's alpha measure was calculated to assure internal consistency. MEASURES AND ANALYSIS: A score was developed for each domain by adding the question's value using the following ranking: never (1), rarely (2), sometimes (3), usually (4), and always (5) and was aggregated in three categories. The calculated sample size needed was 1000 respondents. The Wald method was used for analysis of the questions' consistency and X2 for the inferential analysis. MAIN RESULTS: The survey included 1256 responses from 101 different countries; 70% of respondents were from Europe. The survey was completed by 1045 (84%) doctors and 199 (16%) nurses. It was noted that 568 professionals (45.2%) had less than 10 years' experience. Among respondents, 80.61% [95% confidence interval (CI) 78.42-82.8] reported that monitoring devices were available, and 74.7% (95% CI 72.28-77.11) reported that protocols for high-risk medication and for triage (66.19%) were available in their ED. The area of greatest concern was the disproportionate imbalance between needs and the availability of staff at times of greatest flow, considered sufficient by only 22.4% (95% CI 20.07-24.69) of doctors and 20.7% (95% CI 18.41-22.9) of nurses. Other critical issues were overcrowding due to boarding and a perceived lack of support from hospital management. Despite these difficult working conditions, 83% of the professionals said they were proud to work in the ED (95% CI 81.81-85.89). CONCLUSION: This survey highlighted that most health professionals identify the ED as an environment with specific safety issues. The main factors appeared to be a shortage of personnel during busy periods, overcrowding due to boarding, and a perceived lack of support from hospital management.

Cholesterol Lowering Therapy: Treat to Target or Reduce the Global Risk? The Unresolved Problem of Residual Risk.

BACKGROUND: Atherosclerotic Cardiovascular Disease (ASCVD) is the first cause of death in Western Countries. Several risk factors contribute to generate atherosclerosis and the preventive therapeutic approaches, in particular statin therapy, reduce the mortality. However, the residual risk in statin treated patients remains significant, despite reaching the low density lipoproteins cholesterol (LDL-C) goals. METHODS: we reviewed the literature published in PUB-MED to discuss the role of residual dyslipidemia in particular high density lipoprotein cholesterol (HDL-C), triglycerides (TGs) and lipoprotein(a) [Lp(a)], genetic factors, suboptimal implementation of lifestyle therapy, mood disorders associated to low compliance to application of evidence-based therapies or related to ASCVD. RESULTS: we summarized the current knowledge on the topic, evidencing its contradictory aspects. CONCLUSION: HDL-C is an important biomarker for predicting cardiovascular risk, but the classical HDL hypothesis is no longer correct and it is now being replaced by the HDL function hypothesis, thought more studies are needed to validate it. The connection between cardiovascular risk and levels of TGs is not so definite. APOE genotype and Lp(a) levels are two genetics factors associated to CV risk. Healthy lifestyle with particular dietetic factors, connected to psychological aspects, are very important for the optimal control of the global risk.