ABSTRACT
Objective To investigate the present situation and reasons of emergency department overcrowding, and put forward effective mitigation strategy. Methods By using input-throughput-outputmodel and choosing the method of fishbone diagram analysis, detaily analysis factors of emergency department overcrowding, then implement three- dimensional intervention in hospital, department, personal. Results Patients who stay>48 h in the emergency department(ED) decreased from 11.9％(15225/127941) to 5.3％(7245/136698); patients who stay > 6 h in the Frist Aid Room of ED decreased from 54.6％(3016/5526)to 17.8％(987/5526), both have statistically significant (χ2=3705.04, χ2=1186.32, P<0.01);before the intervention the National ED Overcrowding Study (NEDOCS) index at 0900, 1300, 2100, 0100 was 234.22 ± 62.31, 253.55 ± 59.26, 303.73 ± 160.24, 187.36 ± 25.73; after the intervention the degree of crowdedness of ED at this four points of time was significantly alleviated, NEDOCS index was 193.09 ± 31.87, 187.09 ± 22.65, 187.36 ± 25.73, 154.03 ± 21.56;there were significant differences between the two groups before and after the intervention (t=2.35-4.32, P<0.05). Conclusions To study and discuss the reasons of emergency department overcrowding, it can effectively relieve the happening of emergency department overcrowding through comprehensive intervention measures such as improve the environment, optimize the process, strengthen emergency medical personnel training and management, improve the service level hospital auxiliary support system.
ABSTRACT
Objective To isolate and identify the pathogenic bacteria from peripheral blood of a patient with septicemia of unknown etiology and to analyze their drug resistance genes.Methods Two peripheral blood samples were collected from the patient after having fever.Several assays including culturing bacteria on blood agar plates by using streaking technique,Gram-staining of bacterial colonies and microscopic observation,VITEK 2-compact automatic bacterium detection and analysis system as well as a sequencing analysis of the 16s rRNA gene were performed to identify the bacterial pathogens in blood samples.Microdilution test was performed to detect the drug susceptibilities of isolated bacteria to antibiotics.Confirmatory tests were performed to detect the production of β-lactamase and extended spectrum β-lactamase by the isolated strains and the phenotypes of AmpC enzyme and carbapenemase.PCR was used to identify the β-lactamase-encoding genes in the isolated strains by using the primers of 19 common β-lactamase-,AmpC enzyme-and carbapenemase-encoding genes in Enterobacteriaceae strains and the primers of 21 annotated gene sequences encoding the β-lactamase of a Ralstonia mannitolilytica strain.The PCR products were sequenced and analyzed after T-A cloning.Results Ralstonia mannitolilytica strains were isolated from the two peripheral blood samples.The isolated strains were sensitive to ceftriaxone,cefepime,ciprofloxacin,ofloxacin,tigecycline and compound sulfamethoxazole (SMZ-TMP),but resistant to the other 11 tested antibiotics.Results of PCR amplification by using the primers of common genes encoding β-lactamase of Enterobacteriaceae strains were all negative.Fragments of genes encoding the β-lactamase of the isolated Ralstonia mannitolilytica strain were successfully amplified,which were TK49_09850,TK49_12955,TK49_14470,TK49_14495and TK49_18990.The sequences of the amplified gene fragments were not similar to those of the common β-lactamase-encoding genes in Enterobacteriaceae strains.Conclusion The patient was infected with Ralstonia mannitolilytica.The isolated Ralstonia mannitolilytica strain showed a high-level drug resistance with a noticeable diversity against different β-lactam antibiotics.The genes encoding β-lactamase of the isolated Ralstonia mannitolilytica strain were completely different to those of Enterobacteriaceae strains.