Experience of resources management on coronavirus disease 2019 epidemic at a tertiary medical center in Northern Taiwan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes infectious symptoms including fever, cough, respiratory and gastrointestinal symptoms, and even loss of smell/taste and to date had caused 489 000 people to be infected with 32 000 deaths. This article aims to develop some strategies in dealing with the COVID-19 epidemic to prevent nosocomial infection and ensure the safety of healthcare workforce and employees. METHODS: This is a prospectively registered and retrospective descriptive study investigating the clinical characteristics, results of diagnostic tests, and patients' disposition from February 1, 2020, to April 30, 2020, at a tertiary medical center in Northern Taiwan. RESULTS: There is no nosocomial spreading of SARS-CoV-2 in our facility. The following strategies were followed: information transparency; epidemic prevention resources planning by authorities; multidisciplinary cooperation; informative technologies; immigration quarantine policies; travel restrictions; management of diversion/subdivision; self-health monitoring; social distancing; screening of travel, occupation, contact, and cluster (TOCC) history; traffic control bundling (TCB); training of using personal protective equipment; real-name visiting management; and employee care. The patients' basic characteristics and diagnostic results were gathered. Of the 3832 cases, about 25.9% had travel history. Most of them were traveling to Asia (419 people/time, 10.9%) and from China (256 people/time, 6.7%). Meanwhile, healthcare personnel accounted for 316 people/time (8.3%) and cleaning personnel, 6 people/time (0.16%). The 36 cases who care or have contact with confirmed cases have negative results from the COVID-19 test. The most frequent symptoms were fever and upper respiratory infection followed by gastrointestinal symptoms. CONCLUSION: The above strategies were followed. Patients were stratified based on the risk of TOCC history assessment to ensure the safety of healthcare personnel and patients' appropriate and timely medical services.

Using Simulation Training to Promote Nurses' Effective Handling of Workplace Violence: A Quasi-Experimental Study.

Background: Workplace violence in the health care sector has become a growing global problem. Research has shown that although caregivers comprise a high-risk group exposed to workplace violence, most of them lacked the skills and countermeasures against workplace violence. Therefore, through a quasi-experimental design, this study aimed to investigate the effectiveness of situational simulation training on the nursing staffs' concept and self-confidence in coping with workplace violence. Methods: Workplace violence simulation trainings were applied based on the systematic literature review and the conclusions from focus group interviews with nursing staff. Data were obtained from structured questionnaires including: (1) baseline characteristics; (2) perception of aggression scale (POAS); and (3) confidence in coping with patient aggression. Results: The results revealed that training course intervention significantly improved the nursing staffs' self-perception and confidence against workplace violence (p < 0.001). Conclusions: The "simulation education on workplace violence training" as the intervention significantly improved the workplace violence perception and confidence among nursing staffs in coping with aggression events.

Comparative clinical practice of residents and attending physicians who care for pediatric patients in the emergency department.

OBJECTIVES: The purpose of our study was to explore the effect of the physician's training level on the emergency management of common illnesses in the pediatric emergency department (ED). Our hypothesis was that physicians in training used more resources than attending physicians did in caring for pediatric patients in the ED. METHODS: We retrospectively reviewed all records of patients younger than 18 years who presented to the pediatric section in ED of Taipei Veterans General Hospital between January 1, 2004, and December 31, 2005. The cohort study was composed of patients treated by a pediatric attending physician (group 1) or treated by a resident (group 2). We collected their demographic data, diagnoses, admission and revisiting rates, direct costs (including radiographic, laboratory, and medication costs per visit), and utilization data. RESULTS: Admission and 72-hour revisiting rates did not differ between groups. Lengths of ED stay and total, radiographic, and medication costs significantly increased with the residents (all P < 0.001). Residents ordered more radiographic (30.7% vs 23.8%, P < 0.001) and laboratory (37.2% vs 34.6%, P = 0.13) studies than attending physicians did, notably when patients had acute bronchitis and bronchiolitis or noninfectious gastroenteritis and colitis. Residents also ordered more laboratory studies in cases of pneumonia. CONCLUSIONS: Residents treating pediatric patients in the ED spent more time and used more medical resources than attending physicians did. An important educational objective is to improve physicians' diagnostic skills to reduce resource utilization and to improve outcomes.

The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems.

Improved survival outcome with continuous chest compressions with ventilation compared to 5:1 compressions-to-ventilations mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

BACKGROUND: Fewer pauses and better chest compression quality are thought to improve overall survival following cardiac arrest. This study aimed to measure the outcomes of adult nontraumatic out-of-hospital cardiac arrests (OHCAs) treated with 5:1 compressions-to-ventilations (Thumper 1007) or continuous chest compressions with ventilation (Thumper 1008 CCV) mechanical cardiopulmonary resuscitation (CPR) within a specified period of time. METHODS: A retrospective observational cohort study of 515 adults with OHCA was conducted at the emergency department of an urban tertiary hospital. There were 307 patients in the Thumper 1007 phase (January 2008 to December 2009) and 208 patients in the Thumper 1008 CCV phase (January 2010 to May 2011). Return of spontaneous circulation (ROSC) and survival to hospital discharge were the primary outcome measures. RESULTS: Patients in the Thumper 1007 and Thumper 1008 CCV phases had comparable results with the following exceptions: less hypertension (42.4% vs. 62.0%), cerebrovascular accidents (11.4% vs. 25.0%), and faster emergency medical service response time intervals (mean, 3.7 vs. 4.5 minutes) with the Thumper 1007. The average ambulance transport time was 6.1 minutes in both phases. The rates of ROSC [35.1% vs. 23.5%; adjusted odds ratio (OR), 1.616; 95% confidence interval (CI), 1.073-2.432] and survival to hospital discharge (10.1% vs. 4.2%; adjusted OR 2.431; 95% CI, 1.154-5.120) were significantly higher with the Thumper 1008 CCV than with the Thumper 1007. Favorable neurologic outcome upon discharge, defined as cerebral performance category scores of 1 (good performance) or 2 (moderate disability), was not significantly different between the two phases [1.6% (5/307) vs. 1.9% (4/208); p = 0.802]. The Thumper 1008 CCV provided significantly faster average chest compression rates and shorter no-chest compression intervals than the Thumper 1007 after activation. CONCLUSION: In an emergency department with short ambulance transport times, continuous chest compressions with ventilation through mechanical CPR showed improved outcomes, including ROSC and survival to hospital discharge, in an adult with OHCA. However, there are a variety of confounding influences that may affect the validity of conclusions that have been drawn.

Emergency department (ED) utilization of oldest old men in a veterans care home in Taiwan.

ED is a common channel for older people to seek for medical services. However, unlike most care homes in the world, veterans care home in Taiwan has a constantly operating outpatient and inpatient services. Therefore, utilization of ED services among veterans care home may be different from most care home residents. Records of residents in Banciao Veterans Home residents visiting the ED of Taipei Veterans General Hospital from January to December of 2006 were retrospectively collected and analyzed. Demographic variables including age, sex, modes of arrival, category of triage, time of visit, main presenting symptoms, principal diagnosis, medical expenditure and the disposition after the ED visit or after admission to wards were carefully recorded. In total, 368 residents (mean age=81.9+/-5.9 years, all men) with 635 visits were identified. Nearly a half of Banciao Veterans Home residents had visited ED for at least once in 2006 and the medical expenditure was four times higher than other ED visitors. In average, 52.3% of ED visitors would be hospitalized and the most common diagnosis was infectious conditions. Onsite primary care geriatricians may play an important role in such settings.

Emergency department (ED) utilization and outcome of oldest old men presenting with geriatric syndromes in a veterans care home in Taiwan.

The first presentation of elderly people in the emergency department (ED) is commonly nonspecific and atypical, often in the form of geriatric syndromes, i.e. falls, immobility, incontinence, or deteriorating mental function. The purpose of this study was to evaluate the management and outcomes of institutionalized elderly people who initially presented with geriatric syndrome (GS) in the ED. A retrospective chart review of Banciao Veterans Care Home residents who visited the ED of a tertiary medical center was done. Demographic data including age, sex, modes of arrival, category of triage, time of visit, main presenting symptoms, principal diagnosis, medical expenditures, and clinical outcomes were recorded. From January to December, 2006, 629 ED visits (mean age, 82.1+/-5.3 years, all male) were retrieved. The overall prevalence of GS was 23.8%. When GS subjects were admitted, they were more likely to be transferred to step-down community hospitals for post-acute care (OR = 2.63; 95% CI: 1.36-5.08, p = 0.004). GS was common in institutionalized elderly people calling for ED services, and GS subjects were more likely to be transferred to step-down community hospitals after hospitalization. Comprehensive geriatric assessments may be of value for institutionalized elderly patients visiting the ED.

Development and comparison of user acceptance of advanced comprehensive triage PDA support system with a traditional terminal alternative system.

An advanced PDA support system for the triage was designed to evaluate users inverted exclamation mark | acceptance of this system compared with a traditional terminal system. Davis inverted exclamation mark | Technology Acceptance Model was used to evaluate users inverted exclamation mark | acceptance. All 72 ER nurses in a 2700-bed medical center were invited for the study. The results showed that the PDA system was easier to operate than the terminal one, but had worse interface. The subjects showed significantly greater willingness to accept the terminal system instead of the PDA system. The comparative acceptance of PDA, compared with that of the old system, might still be marginally too low if its interface couldn inverted exclamation mark |t be improved or no other unique practical benefits could be verified.