Browsing by Subject "emergency department"

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  • Lehto, Mika; Mustonen, Katri; Kantonen, Jarmo; Raina, Marko; Heikkinen, Anna-Maria K.; Kauppila, Timo (2019)
    This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were (a) application of ABCDE-triage combined with public guidance on the proper use of EDs, (b) cessation of a minor supplementary ED, and finally (c) application of "reverse triage" with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.
  • Lehto, Mika; Mustonen, Katri; Raina, Marko; Kauppila, Timo (2021)
    To determine the extent to which it is possible to provide continuity of primary care for those who visit Emergency Departments (EDs) we studied how recorded diagnoses in primary care differ, depending on whether the patient is met in an ED or a primary care office-hours practice. In the present, 12-year follow-up study a report generator of the Electronic Health Record-system provided monthly figures for the number of different recorded diagnoses using the International Classification of Diagnoses (10(th)edition, ICD-10) and the total number of ED doctors and office-hour visits to General Practitioners (GPs). The 20 most common diagnoses covered 48.1% of the visits with recorded diagnoses to the office hour GPs and 45.9% of the visits to the doctors of the ED. Of these 20 diagnoses, 10 were common in both systems. These 10 diagnoses constituted about 30% of the diagnoses given by ED doctors. Furthermore, five out of the six most common diagnoses were the same in the ED and office-hours practices. The doctors in EDs and office-hour GPs treat quite similar patient material. This may provide organisational ways to reorganise the work of primary care and to guarantee continuity of care for those who may benefit from it.
  • AANZDEM Study Grp; EURODEM Study Grp; Laribi, Said; Harjola, Veli-Pekka (2019)
    Objective The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. Patients and methods An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. Results A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. Conclusion Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.
  • the AANZDEM and EuroDEM study groups; Kelly, Anne-Maree; Van Meer, Oene; Laribi, Said (2020)
    Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non-invasive ventilation (NIV) for patients with respiratory acidosis. Aim: To determine compliance with guideline recommendations for patients treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. Methods: In each region, an observational prospective cohort study was performed that included patients presenting to ED with the main complaint of dyspnoea during three 72-h periods. This planned sub-study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in-hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. Results: A total of 801 patients was included from 122 ED (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44 and 60.6% of patients with pH Conclusion: Compliance with guideline recommended treatments, in particular administration of corticosteroids and NIV, was sub-optimal in both regions. Improved compliance has the potential to improve patient outcome.
  • Puuskari, Varpu; Aalto-Setälä, Terhi; Komulainen, Erkki; Marttunen, Mauri (2017)
    Background: Increasing psychiatric disorders and alcohol intoxication challenge the pediatric emergency departments (PEDs) to which adolescents are referred owing to acute alcohol intoxication. Objective: This study examined the degree to which adolescents presenting to PED with alcohol intoxication or deliberate self-harm report symptoms of depression and how they differed from non-depressed patients in terms of alcohol use, perceived social support, psychological distress, self-esteem, and suicidal thoughts. Methods: In a sample of 138 adolescents, 12- to 16-years old (62 % females), we assessed the patients' psychiatric status using self-report scales and analyzed blood samples for alcohol. Before discharge, a consulting psychiatrist interviewed each patient to evaluate possible suicidality and organized aftercare when necessary. The mediating data-driven hypothesis was examined. Adolescents scoring >= 10 on the Beck Depression Inventory (BDI) were deemed as screening positive for depression. Results: In 55% of participants, intoxication was by alcohol consumption. Deliberate self-harm was found in 17% of the participants. Of the 138 adolescents, 39 % scored positive on the BDI for depressive symptoms, occurring more commonly in girls. Logistic regression showed that the most significant variables associated with depressive symptoms were female gender, high psychological distress, and low self-esteem. Symptoms of depression served as a mediator between gender and self-esteem and the blood alcohol level. Conclusions: Our findings underscore the importance of identifying mood disorders, suicidality, and self-esteem among adolescents with acute alcohol intoxication at the PED. Intensive psychiatric evaluation in an emergency department is necessary in order to detect those adolescents requiring additional treatment and support.
  • EURODEM Study Grp; Karamercan, Mehmet Akif; Dundar, Zerrin Defne; Ergin, Mehmet; Harjola, Veli-Pekka; Laribi, Said (2020)
    Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from El), and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (53-80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P <0.001) and had a lower rate of ambulance arrival to ED (P <0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.
  • Harjola, Pia (Helsingfors universitet, 2016)
    Background: Real-life data on the role of emergency medical services (EMS) in acute heart failure (AHF) are scarce. Our aim was to describe prehospital treatment of AHF and to compare patients using EMS with self-presented, non-EMS patients. Methods: Data were collected retrospectively from three university hospitals in Helsinki metropolitan area between July 1 2012 and July 31 2013. According to the use of EMS, patients were divided into EMS and non-EMS groups. Results: The study included 873 AHF patients. One hundred were (11.5%) EMS and 773 (88.5%) non-EMS. EMS patients tended to have more comorbidities. Initial heart rate (HR) and peripheral oxygen saturation (SpO2) differed between EMS and non-EMS patients; mean HR 89.2 (SD 22.5) vs. 83.7 (21.5) /min (p=0.02) and SpO2 90.3 (8.6) vs. 92.9 (6.6)% (p=0.01). However, on presentation to ED EMS patients' vital signs were similar to non-EMS patients'. On presentation to ED 46.0% were normotensive and 68.2% "warm and wet". Thirty-four percentage of EMS patients received prehospital medication. In-hospital mortality was 6.0% and 7.1% (p=0.84) and length of stay (LOS) 7.7 (7.0) and 8.5 (7.9) days (p= 0.36) in EMS and non-EMS groups. Conclusion: The use of EMS and administration of prehospital medication was low. EMS patients had initially worse HR and SpO2 than non-EMS patients. However, EMS patients' signs improved and were similar on presentation to ED. There was no difference in in-hospital mortality and LOS. This underscores the need for equal attention to any AHF patient independent of the arrival mode.
  • Lehto, Mika; Pitkälä, Kaisu; Rahkonen, Ossi; Laine, Merja K.; Raina, Marko; Kauppila, Timo (2021)
    Objective This study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED). Design A register-based 12-year follow-up study with a before-and-after design. Setting This study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record. Subjects and main outcome measures The report generator of the electronic health record-system provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders. Results The most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention. Conclusion Electronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions.
  • Kankaanpää, Meri (Helsingfors universitet, 2016)
    Background: To assess whether the use of point-of-care testing (POCT) and early assessment team (EAT) model shortens emergency department (ED) length of stay (LOS). Methods: This observational study was performed in three phases in a metropolitan ED with 57,000 annual visits. Data were collected from adult ambulatory patients who were discharged home. Phase 1 served as a control (n=1559 in one month). In phase 2, a comprehensive POCT panel including complete blood count, sodium, potassium, glucose, C-reactive protein, creatinine, alkaline phosphatase, alanine aminotransferase, bilirubin, amylase, and D-dimer was launched (n=1442 in one month). In phase 3 (n=3356 in subsequent two months), POCT approach continued. In addition, the working process was changed by establishing an EAT consisting of an emergency medicine resident and a nurse. The team operated from 12 noon to 10 p.m. was. The primary outcome was LOS (hh:mm) in the ED. Waiting times for patients requiring laboratory testing were analysed also, including time from admission to laboratory blood sampling (A2S interval), time from blood sampling to results ready (S2R interval) and time from results to discharge (R2D interval). Results: Median LOS of patients requiring laboratory tests in phase 1 was 3:51 (95% confidence interval 03:38–04:04). During phase 2, introduction of POCT reduced median LOS by 29 minutes to 03:22 (03:12–03:31, p=0.000). In phase 3, the EAT model reduced median LOS further by 17 minutes to 03:05 (02:59–03:12, p=0.033). Altogether, the process was expedited by 46 minutes compared with the phase 1. Surprisingly, A2S interval was unaffected by the interventions among all patients needing laboratory testing. In comparison to phase 1, shortening of S2R interval was observed in phase 2 and 3, and that of R2D interval in all patients with laboratory assessments in phase 3. Conclusions: The advantage of POCT alone compared with central laboratory seemed to lie in shorter waiting times for results and earlier discharge home. Moreover, POCT and EAT model shorten LOS additively compared with conventional processes. However, a longer time is seemingly needed to adopt a new working process in the ED, and to establish its full benefit.