How can be reduced discharges against medical advice from the emergency department?

Objective@#Discharge against medical advice (DAMA) from emergency departments (EDs) accounts for 0.1% to 2.7%. DAMA carries a risk of increased mortality and readmissions, and higher medical nationwide cost. Our aim was to investigate the general characteristics of DAMA patients from ED and discover for methods to reduce DAMA. @*Methods@#In this study, we collected and analyzed the medical records of patients who visited the ED of a general hospital from 2015 to 2020. The subjects were categorized into a DAMA group and a non-DAMA group. We compared these groups with respect to gender, age, duration of ED stay, way to visit, the reason for the visit, insurance type, accompanied by guardian, and severity classification. In addition, the factors related to ED revisits or hospitalization within one month after DAMA were analyzed. @*Results@#Of the 209,076 patients, 1,982 were subject to DAMA from ED. The DAMA group had a higher ratio of visits to ED by ambulance (53.2% vs. 21.4%, P<0.001), critically ill patients (74.1% vs. 51.7%, P<0.001), and medical aid type 1 (7.7% vs. 3.4%, P<0.001). The factors for the high ratio of ED revisit within one month after DAMA were as follows: critically ill patients (odds ratio [OR], 1.916; 95% confidence interval [CI], 1.305-2.814), accompanied by a guardian (OR, 1.525; 95% CI, 1.105-2.105), and medical aid type 1 (OR, 2.025; 95% CI, 1.358-3.02). @*Conclusion@#Developing a manual on DAMA procedures and a system that can provide economic and social support to patients is to be established to reduce DAMA from ED.

Efficacy of transthoracic echocardiography performed by emergency physician in patients with suspected acute coronary syndrome in the emergency department

Objective@#This study examined the efficacy of trans-thoracic echocardiography (TTE) performed by emergency physicians in the diagnosis and treatment of acute myocardial infarction (MI) in patients with suspected acute coronary syndrome (ACS). @*Methods@#This study enrolled patients with suspected symptoms of ACS from January 1, 2017, to June 30, 2017, in the emergency department (ED). One hundred and eighteen patients, who underwent TTE (TTE group), and 384 patients, who did not undergo TTE (control group), were enrolled in this study. The rate of performed coronary angiography (CAG) and percutaneous coronary intervention (PCI) were analyzed in the TTE group. The primary outcomes included the rate of CAG and PCI performed and door-to-puncture time (DTPT). @*Results@#The rates of CAG and PCI were significantly higher in the TTE group than in the control group (CAG: 38% vs. 28%, P=0.039; PCI: 31% vs. 21%, P=0.034). The mean DTPT in non-ST segment elevation was 110 minutes (110.2±38.86 minutes) in the TTE group and 151 min (151.3±108.01 minutes) in the control group (P=0.054). @*Conclusion@#Patients with suspected ACS in ED with TTE had a higher rate of CAG and PCI performed compared to the patients without TTE. In patients with non-ST segment elevation in the initial electrocardiogram, TTE performed by emergency physicians tended to shorten the time to diagnose MI and DTPT.

Efficacy of transthoracic echocardiography performed by emergency physician in patients with suspected acute coronary syndrome in the emergency department

Objective@#This study examined the efficacy of trans-thoracic echocardiography (TTE) performed by emergency physicians in the diagnosis and treatment of acute myocardial infarction (MI) in patients with suspected acute coronary syndrome (ACS). @*Methods@#This study enrolled patients with suspected symptoms of ACS from January 1, 2017, to June 30, 2017, in the emergency department (ED). One hundred and eighteen patients, who underwent TTE (TTE group), and 384 patients, who did not undergo TTE (control group), were enrolled in this study. The rate of performed coronary angiography (CAG) and percutaneous coronary intervention (PCI) were analyzed in the TTE group. The primary outcomes included the rate of CAG and PCI performed and door-to-puncture time (DTPT). @*Results@#The rates of CAG and PCI were significantly higher in the TTE group than in the control group (CAG: 38% vs. 28%, P=0.039; PCI: 31% vs. 21%, P=0.034). The mean DTPT in non-ST segment elevation was 110 minutes (110.2±38.86 minutes) in the TTE group and 151 min (151.3±108.01 minutes) in the control group (P=0.054). @*Conclusion@#Patients with suspected ACS in ED with TTE had a higher rate of CAG and PCI performed compared to the patients without TTE. In patients with non-ST segment elevation in the initial electrocardiogram, TTE performed by emergency physicians tended to shorten the time to diagnose MI and DTPT.

Epidemiologic Study of Systemic Inflammatory Response Syndrome in Emergency Department

PURPOSE: Epidemiologic data on emergency department (ED) patients with systemic inflammatory response syndrome (SIRS) are limited. We examined the prevalence, risk factors, etiologies and outcomes for the various forms of the SIRS, as well as their relationships with infection in ED. METHODS: The subjects were 16,718 non-trauma adult patients who visited a 900- bed university hospital ED between November 2006 and October 2007. ED records were reviewed, and all patients meeting the criteria for SIRS were enrolled retrospectively. SIRS patients were further subdivided into four groups (non-infectious SIRS, sepsis, severe sepsis, septic shock). Baseline characteristics, ED dispositions, and prognoses of patients in each group were analyzed. RESULTS: Among 16,718 patients, there were 2,790 SIRS patients (16.7%). The SIRS patient group was composed of 1,546 non-infectious SIRS patients (55.4%), 1,078 sepsis patients (38.6%), 119 severe sepsis patients (4.3%), and 47 septic shock patients (1.7%). ED patients with SIRS were older on average than non-SIRS patients (52 versus 48, p<0.001). The most common sources of SIRS was the gastrointestinal system (28.3%), followed by the respiratory system (22.9%) and the genitourinary system (11.8%). Pneumonia (18.9%) was the single most common cause of infectious SIRS. The admission rate was higher for SIRS patients than for non-SIRS patients (44% versus 21%). The 28-day mortality rate for non-infectious SIRS, sepsis, severe sepsis, and septic shock patients were 4.5%, 1.3%, 25.2%, and 63.8%. Sepsis severity was correlated with increased rates of both hospital admission and mortality (p<0.001). CONCLUSION: 55% of SIRS patients who visited the ED had a non-infectious cause. SIRS patients were older than non-SIRS patients, and hospital and ICU admission rates were also higher. Sepsis severity was correlated with older age, increased hospital admission rate, increased ICU admission rate, and increased mortality rate.