Frontiers in Emergency Medicine (E-Journal)
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What Can We Do to Improve Patient Satisfactıon in the Emergency Department? A Prospective Study in a Turkish University Hospital
Get PDFIntroduction: In recent years, patients' satisfaction with emergency medical services provided to them has been one of the main criteria in the evaluation of the quality of these services. Objective: The goal of our study was to determine the factors that affect the satisfaction of patients admitted to the emergency department (ED) and to provide new regulations. Method: This prospective and descriptive study included 341 patients who utilized the ED services of a university hospital between October 1, 2004, and June 30, 2005. The patients' demographic and visit characteristics, waiting times, and the total duration of stay in the ED were noted in the prepared questionnaire. In addition, all patients were asked to indicate their level of satisfaction with the care received in the ED based on a five-point Likert scale. The results were analyzed using ANOVA, chi-square, and logistic regression tests. Results: Of the 341 patients, 219 (64.2%) were satisfied with the care they had received in the ED. Factors such as doctor and nurse behavior, medical information, the frequency of doctors and nurses visits, the ease of access to personnel, the cleanliness of the ED, and the availability of technical equipment had a statistically significant effect on the overall satisfaction of the patients (p < 0.05). Conclusion: The quality of patient care provided and the features of the ED determine the patients’ satisfaction with the ED services
Sample Size Calculation Guide - Part 2: How to Calculate the Sample Size for an Independent Cohort Study
Get PDFIn the previous article, we explained how to calculate the sample size for a cross-sectional study based on a rate or a single proportion. In this article, we will explain how to calculate the sample size for an independent cohort study based on a comparison of two proportions representing the event rates in both the exposed and the non-exposed groups
The Cost of Leaving the Emergency Department without Notice; a Cross-sectional Study
Get PDFIntroduction: Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country. Objective: The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it. Methods: This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value<0.05 was considered significant. Results: Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p<0.001). The total cost inflicted by leaving without notice throughout the studied year was 1,755,286,279 Rials, which is equal to 0.0059 of the total annual income of the ED. Conclusion: Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED
Dr. Naeem Toosy, MBChB, MSc, FRCS (Ed), FRCEM; Consultant and Acting Head of Department of Emergency Medicine at Sheikh Khalifa General Hospital
Get PDFCritical Care Medicine: Bangladesh Perspective
Get PDFBangladesh became an independent and sovereign country in 1971 following a nine-month blood shedding liberation war. Bangladesh has a population of about 152.25 million, making it one of the most populous countries in the world. Intensive care is an emerging but less emphasized concept in Bangladesh. The first intensive care unit (ICU) in Bangladesh was established in the National Institute of Cardiovascular Diseases (NICVD) in 1980. Since then many ICUs have been established. In Bangladesh there is no governing body like Bangladesh Medical and Dental Council (BMDC) that can set the standard of such units. There are no reliable statistics regarding the number of both governmental and private ICUs, bed capacities, no. of patients getting admitted per month, services offered, equipment, qualification of health professionals, cost/benefits and mortality rates of these ICUs
Gender-Based Violence Causing Severe Multiple Injuries; a Case Report
Get PDFIntroduction: Gender-based violence (GBV) against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk
An Interesting Case of Isolated Pancreatic Transection Following Blunt Abdominal Trauma in Emergency Department
Get PDFIntroduction: Traumatic injury to the pancreas is not common, but if the diagnosis is delayed or misdiagnosed in the emergency department (ED), the condition is associated with high morbidity and mortality and raises a question about the quality of emergency care. Here, we describe a rare case of blunt abdominal trauma resulted in isolated pancreas injury. Case presentation: A 25-year-old young male came to our emergency room (ER) in a conscious, anxious state from a nearby town with a history of roadside trauma. Further investigations revealed an isolated pancreatic injury due to trauma with no other major injuries, which occurred due to a sudden high-speed impact of the steering wheel to the epigastrium of a driver while driving the car, severely compressing the pancreas between the backbone and steering wheel. The patient was admitted to the intensive care unit for close observation and monitoring. He was managed conservatively on intravenous fluids, antibiotics, analgesics, and vasopressors. He was discharged after five days in a hemodynamically stable and afebrile condition, on a normal diet. Conclusion: Isolated pancreatic injury following blunt abdominal trauma is rare, and the symptoms are difficult to analyze early due to its retroperitoneal anatomy. Early detection and early intervention are important in the ED, and if left unrecognized, could result in a poor outcome
Facial hyperpigmentation: Any link to cancer?
Get PDFIntroduction: Ectopic adrenocorticotropic hormone (ACTH) syndrome is recognized by edema, proximal muscle weakness, hypertension, diabetes and skin hyperpigmentation. This syndrome is mainly associated with malignancies. Case presentation: A 43-year-old woman came to our hospital with a history of new-onset diabetes, hypertension, edema and facial hyperpigmentation from four months before. Upon admission, she had alkalosis, hypokalemia, mild hypertension and low-grade fever. Due to abdominal pain, an abdominal ultrasound was performed, which revealed common bile duct (CBD) and pancreatic duct dilation. The abdominopelvic computed tomography (CT) scan showed a poorly-enhancing mass in the periampullary region. Conclusion: The patient's facial hyperpigmentation and hypokalemia appear to have been due to ACTH ectopic syndrome as a result of periampullary cancer
To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule
Get PDFIntroduction: The Ottawa Subarachnoid Hemorrhage rule (OSR) is a clinical decision tool identified for ruling out subarachnoid hemorrhage (SAH) in those patient above 15 years of age who present to the emergency department (ED) with acute onset atraumatic headache. Objective: The primary objective of this study was to externally validate the OSR in a single national health service (NHS) setting in the UK and secondly, to compare it with our current practice without using a decision rule. Method: A retrospective review of computerized medical records was done for all patients registered with headaches from January to December 2016. The data were manually charted on a data sheet from individual patient records. Patients fulfilling the preset inclusion and exclusion criteria as per the OSR were enrolled in the analysis. According to the OSR, if patient had any of the 6 criteria enlisted (age > 40 years, neck stiffness/pain, witnessed loss of consciousness, onset during exertion, thunderclap headache, limited neck flexion on examination), further diagnostic decision was required. All patients were followed up for 6 months on the computer system as it gets highlighted if the patient is represented again to the ED or is deceased. Results: A total of 737 ED visits with acute headache were reviewed for potential eligibility. Out of these, 649 were estimated to be eligible. On excluding 485 patients that could not meet the predetermined inclusion criteria and 19 patients as per the exclusion criteria, 145 (19.7%) patients were included in the analysis. There were 5 cases of SAH, yielding an incidence of 3.4 % (95% CI 1.3 % – 8.3 %). The sensitivity for SAH was 100% (95% CI, 46.3 % - 100 %); specificity of 44.2 % (95% CI, 36 % - 53 %); positive predictive value of 6.02 % (95% CI 2.2 % - 14.1 %); and negative predictive value of 100% (95% CI, 92.7 % - 100%). Conclusion: Although being poorly specific, the OSR is a highly sensitive, simple tool for ruling out SAH in alert patients with a headache in ED settings
Flight Attendant’s Perspective on the Medical Professional’s Presence During In-Flight Cardiopulmonary Resuscitation
Get PDFAbout 95% of the two billion airlines passengers suffered from health issues (1). Furthermore, a call center in North Carolina noted that there were 16 in-flight emergency cases for every 1 million airlines passengers (2). Cardiac arrest is one of these cases, which is a cause for mortality for about 1000 people during the flights (3). Cardiopulmonary resuscitation (CPR) can be demonstrated by the medical professionals or trained people such as flight attendants. Commercial flights usually do not have official medical staffs on board. Hence, whenever there are in-flight medical emergency cases, flight attendants should be trained to manage such cases. Flight attendants themselves are laymen who are trained to do basic medical emergency interventions, that is, even if they intervene in such cases, they cannot take an appropriate decision as the medical professionals.
During in-flight cardiac arrest, the flight attendants are mainly responsible to immediately contact the ground staff and voluntary medical professionals on board; besides, they also have a right to perform CPR (4). Certain airlines such as Air Canada and Scandinavian Airlines have policies related to medical supervision. They apply emergency telemedicine that involves emergency specialists as the commander (5). Furthermore, the specialists will assign some instructions for the flight attendants who manage the in-flight medical emergencies (5). In contrast, in Indonesia, in case of any in-flight medical emergency, the flight attendants would announce on call asking for the presence of any medical professionals on board; however, no official medical professionals are recruited on board by the airlines for any medical casualties or emergency.
Attendant expressed that the rescuer had many senses while helping people with in-flight medical emergency like shocked while looking at the victim. Contrary, the rescuer also determined to take her responsibility as a cabin crew by helping the victim. Furthermore, she had to manage her dilemma before doing that.
The flight attendant has already expressed her suggestion on having in-flight medical professionals so that she can focus on her responsibility as a cabin crew. NBAA (2016) declares that commercial airlines are suggested to make policies that involve medical professionals in managing in-flight medical emergency (6). These will make flight attendants feel comfortable in serving the passengers. Consequently, the flight attendant needs medical companionship while performing CPR on board. Hence, in-flight medical emergency management, which is part of prehospital management, can be guarantee