A study on the discharge against medical advice in the emergency room from the communication perspective / 의료커뮤니케이션

Background@#: It is called a discharge against medical advice (DAMA) that a patient needs continuous medical care, but leaving the hospital contrary to a doctor’s medical advice. DAMA also occurs in the emergency room, and sometimes it can make the patient's symptoms and states worse or even lead to death. @*Methods@#: @*Results@#: There are various reasons for deciding to DAMA. Among those reasons, the poor communication skills of medical staff can cause the disease insight of patient to be lowered, create unsatisfactory medical services, and create distrust for the medical staff. @*Conclusion@#: Medical staff can lower the frequency of DAMA through following patient-oriented communication : listening to the patient's symptoms and information, talking to the patient in an easy-to-understand language, and conducting two-way communication with appropriate feedback.

Variations in chest compression time, ventilation time and rescuers' heart rate during conventional cardiopulmonary resuscitation in trained male rescuers

OBJECTIVE: This study was conducted to determine why rescuers could maintain adequate chest compression depth for longer periods during conventional cardiopulmonary resuscitation (CPR).METHODS: Various CPR parameters, including average compression depth (ACD), average compression rate, average ventilation time (AVT), and rescuers’ heart rates were recorded in real-time when 20 health care providers performed 10 minutes of conventional CPR during a simulation experiment.RESULTS: The ACD was maintained above 50 mm and was not significantly different during 19 consecutive CPR cycles. The average compression rate increased from 114.9±10.0/min (2nd cycle) to 120.1±13.8/min (18th cycle) (P=0.007), and the AVT increased from 8.7±1.5 seconds (3rd cycle) to 10.1±2.6 seconds (18th cycle) (P=0.002). The rescuers’ heart rates also increased gradually for 10 min; however, they increased rapidly and were highest during the ventilation phase. Their heart rates then decreased and were lowest during the early chest compression phases of each CPR cycle. Decreases in heart rates were significant in all CPR cycles (average decrease: 14.5±4.5 beats/min, P<0.001).CONCLUSION: The ACD was maintained adequately during 10 minutes of conventional CPR. However, the AVT increased significantly during the 10-minute period. The rescuers’ heart rates increased and decreased throughout all CPR cycles. These results showed that the ventilation phase might play a role as a resting period and be a reason for the maintenance of adequate chest compression depth for prolonged periods during conventional CPR.

Which Fingers Should We Perform Two-Finger Chest Compression Technique with When Performing Cardiopulmonary Resuscitation on an Infant in Cardiac Arrest?

This study compared the effectiveness two-finger chest compression technique (TFCC) performed using the right vs. left hand and the index-middle vs. middle-ring fingers. Four different finger/hand combinations were tested randomly in 30 healthcare providers performing TFCC (Test 1: the right index-middle fingers; Test 2: the left index-middle fingers; Test 3: the right middle-ring fingers; Test 4: the left middle-ring fingers) using two cross-over trials. The "patient" was a 3-month-old-infant-sized manikin. Each experiment consisted of cardiopulmonary resuscitation (CPR) consisting of 2 minutes of 30:2 compression: ventilation performed by one rescuer on a manikin lying on the floor as if in cardiac arrest. Ventilations were performed using the mouth-to-mouth method. Compression and ventilation data were collected during the tests. The mean compression depth (MCD) was significantly greater in TFCC performed with the index-middle fingers than with the middle-ring fingers regardless of the hand (95% confidence intervals; right hand: 37.8-40.2 vs. 35.2-38.6 mm, P = 0.002; left hand: 36.9-39.2 vs. 35.5-38.1 mm, P = 0.003). A deeper MCD was achieved with the index-middle fingers of the right versus the left hand (P = 0.004). The ratio of sufficiently deep compressions showed the same patterns. There were no significant differences in the other data. The best performance of TFCC in simulated 30:2 compression: ventilation CPR performed by one rescuer on an infant in cardiac arrest lying on the floor was obtained using the index-middle fingers of the right hand. Clinical Trial Registry at the Clinical Research Information Service (KCT0001515).

Investigation of Emergency Department Violence: Resident Survey

PURPOSE: The Korean Intern Resident Association and Korean Society of Emergency Medicine announced the 'Hospital violence response system' to secure patient safety and provide a health care provider countermeasures against hospital violence. The aim of this study is to investigate the response to hospital violence in the ER and which measures could improve the current status. METHODS: Emergency medicine residents in the Seoul, Incheon, Kyung-gi area participated in the survey. The questionnaire included 4 categories (1. Awareness of protocol, 2. Experience and countermeasure for hospital violence, 3. Understanding of protocol, 4. Suggestions to improve against hospital violence) RESULTS: Among 362 candidates, 236 (65.2%) participated in the survey. Only 7.6% of residents have not experienced hospital violence. In the group of people who were aware of the protocol, participants tended to be more familiar with processes of the hospital violence response protocol, and willing to deal with violence using a better systematic support. People did not counteract to hospital violence because the process was thought to be too complicated. Only 63 participants were actively involved in an official course for countermeasure. Participants suggested that police should deal more appropriately with hospital violence. CONCLUSION: The hospital violence response protocol is thought to have a positive effect on appropriate management of hospital violence. However, a multi-disciplinary approach to hospital violence from the hospital, police, and judicial authority should be developed.

Effectiveness of Medical Student Training and Performance Assessment for Initial Evaluation and Management of Patients with Multiple Trauma, Using Realistic Patient Simulation

PURPOSE: Simulation-based medical education allows medical students to experience scenarios that are otherwise rare to encounter during on-site training. The purpose of our study is to assess the performance of a medical student training program using a realistic, patient simulation for activities including initial evaluation and management, situational judgment, and decision making associated with patients with multiple trauma. METHODS: After a slide lecture and patient simulation training, 46 medical students in their sixth-year were trained using a multiple-trauma patient simulation scenario. The performance assessment checklist included possibilities for both appropriate and inappropriate actions. After debriefing, the students filled out a questionnaire and participated in a feedback session. Two specialists in emergency medicine evaluated the completed checklists. Inter-rater reliability was established for the results. RESULTS: The appropriate action checklist items for obtainment of blood for type and crossmatch, initiation of emergency blood transfusion, and resuscitation with vigorous fluid therapy, resulted in low mean numbers. The inappropriate action checklist items for delay in recognition of tension pneumothorax, blood ordering type and crossmatch, and ordering blood transfusion, resulted in high mean numbers. The inter-rater reliability of these results were 0.90. Students responded in the questionnaire that they appreciated the opportunity to have this training before graduation and that they had learned more about multiple trauma treatment through this training. CONCLUSION: We suggest that this training program, using a realistic patient simulation, can be highly effective for teaching medical students about initial evaluation and management, situational judgment, and decision making in patients suffering with multiple traumas. We also demonstrated the efficacy of simulation as a trauma performance assessment tool for evaluating medical students.