Awareness of Saudi Population about the Role of the Emergency Rooms

Background: The hospital Emergency department (ED) is one of the most important components of the health delivery system. Objectives: To investigate the public awareness of the ERs in KSA, what the public knows about the provided services, and if they know the difference between the outpatient clinic and ERs. Methods: It is a cross-sectional descriptive community-based study carried out on 977 male and female, young and adult participants from all age groups, in different areas of the Kingdom of Saudi Arabia, during the period from 1st January to 31st July 2019. Data was collected through filling the pre-designed online questionnaire which guided us to the needed data. We utilized the SPSS program version 16. The X2 test was used as a test of significance, and differences considered significant at p-value less than 0.05. Results: Most of the participants (87.5%) reported that they know the difference between the outpatient clinic and ER. The majority (68.1%) of subjects said that ERs is meaning rapid and unplanned medical care, 17.3% said any needed health care is available there, 12.2% said that it means insufficient medical care and only 2.5% said it means availability of physician at any time for any purpose. As regards evaluation to the provided services in ERs; 32.5% of cases said it was very good followed by 28.5% good, 19.8% excellent, 10.2% accepted and 10% reported it was bad services. There were significant relations between the awareness and age (p=0.03) and education level (p=0.003), but no relation was found with the gender of the participant (p>0.5). Conclusion: In our study, Most of the participants reported that they know the difference between the outpatient clinic and ERs. The majority of subjects said that ERs is meaning rapid and unplanned medical care and/or availability of physician at any time for any purpose. There were significant relations between the awareness and age and education level, but insignificant relation was found with the gender of the participant.

Intubation Performed In The Emergency Department Is Associated With Increased Pulmonary Complications

Ventilator Associated Pneumonia (VAP) is among the most common hospital acquired infections. Trauma patients are known to have a unique predisposition to the development of pneumonia. At our urban level 1 trauma center, we noticed variability in the incidence of aspiration and pneumonia among intubated patients with similar levels of injury severity. In an attempt to discern why, we hypothesized that location of intubation was a risk factor for development of in-hospital complications. We performed a retrospective cohort study over a 6 month period using adult patients admitted to our trauma service. Intubations performed were reported from four different locations: Emergency Department (ED), operating room (OR), intensive care unit (ICU) and the surgical floor. Data obtained included location of intubation, age, Acute Injury Score (AIS), days on a ventilator, incidence of pulmonary infection, incidence of aspiration, intubation difficulty, ICU length of stay (ICU-LOS), hospital length of stay (HLOS), and survival. One way analysis of variance (ANOVA) was then performed. Our study included 96 enrolled patients consisting of 13 women and 83 men with a mean age of 49.5. Patients intubated in the ED, in comparison to patients intubated on the surgical floor, ICU or OR, were noted to have a statically significant increase in ventilator days (10.9 days), ICU length of stay (12.1 days), HLOS (18.8 days). Additionally, incidence of pulmonary infection (63.9%) and incidence of aspiration (37.7%) were noted to be increased with no statistically significant change in survival. In conclusion, trauma patients requiring emergent intubation in the ED are uniquely predisposed towards development of pneumonia and inhospital morbidity. These patients should be aggressively managed with strategies aimed at VAPprevention.

Objective Clinical Pain Assessment By Independent Service Identifies Significant Gaps In Pain Assessment And Control.

Pain is highly subjective. Standardized measurements are necessary to ensure adequate analgesia. Our objective was to examine whether an independent objective clinical assessment differs from existing provider documented assessment of pain levels. We performed a retrospective analysis of randomly selected patients admitted to the trauma service at our Urban level I Trauma Ctr. (448 bed), over the course of 2 months. During this time period an independent team headed by the trauma medical director (AC) performed pain assessments on these patients using an objective numeric scale, (with 0 being no pain and 10 being the worst possible pain) within 1 hour of scheduled assessment by the primary care givers be they ED, Nursing or Physician. Medical records were reviewed for type of injury, objective pain level as documented on nursing, physician, and emergency department (ED) notes, objective pain level as documented by the independent team, and analgesic treatment. A total of 101 patients were included. Types of injury included fall (n= 38), fall with fracture (n=21), motor vehicle collision (n=19), fracture (n=12), assault (n=8), and miscellaneous (n=3). The mean overall pain level as documented by the independent team was 4.35 ± 0.76; 36 patients reported no pain, 7 patients reported mild pain (level 1-3), 17 patients reported moderate pain (level 4-6), 30 patients reported severe pain (level 7- 9), and 11 patients reported experiencing the worst possible pain (level 10). Pain assessment documentation was missing in 36.6 % of emergency department notes (n=37), 31.1 % of nursing notes (n=32) and 64.4% of physician notes (n=65). Mean pain level varied by ED (5.37 0.85), nursing (1.98 ± 0.67) and physician (2.94 ± 0.96) notes. Analgesic treatment was composed of morphine (n=23), Oxycodone/acetaminophen (n=10), Ibuprofen (n=10), acetaminophen (n=9), acetaminophen/codeine (n=2), ketorolac (n=3), or any combination thereof (n=41). Three patients did not receive analgesic medication. The assessment of pain level was absent in over 30 % of all clinical documentation, with physicians being the worst offenders. Despite receiving pain medication 57.4% of patients reported experiencing moderate to excruciating pain on an objective assessment. Further prospective research is necessary to examine the utility of these ndings on a large scale basis. The utilization of independent objective clinical assessment is valuable to ensure appropriate pain management in trauma patients.

Health Maintenance Organization-Federally Qualified Health Center (HMO-FQHC) Collaboration to Provide After-Hours Pediatric Primary Care: A Feasibility Study.

Aims: Examine feasibility, implementation and impact of a Health Maintenance Organization (HMO)-Federally Qualified Health Center (FQHC) collaboration in providing after-hours care as an Emergency Department (ED) diversion strategy. Study Design: Prospective study using pre-post comparison design. Methodology: Service enhancement program with the addition of after-hours clinic services coupled with a Texas Children’s Health Plan outreach campaign were conducted in Houston, Texas to promote the increased availability of clinic services during a six month period from September 2006 to February 2007 to enrolled Medicaid and State Children’s Health Insurance Program (SCHIP) enrollees. Claims data were used to identify after-hours clinic utilization and a pre-post analysis compared ED use rates of after-hours clinic users, non-users within the service area, and other enrollees in the health plan. Start-up costs provided by community funders amounted to 46,000 dollars (onetime payment) and marketing outreach campaign was supported with 52,000 dollars from TCHP. Results: During the intervention time frame, September 1, 2006 thru February 28, 2007, at least 194 enrollees visited the after-hours clinic. An impact on ED utilization was not found and the six-month post intervention ED utilization for both the intervention and comparison groups increased when compared to the six-month baseline measurement period. Conclusion: Establishing and promoting the after-hours clinic during this project targeting HMO enrollees was determined to be feasible with at least 194 enrollees who resided in the targeted area visiting the after-hours clinic at the FQHC.A six-month study period was long enough to examine the feasibility of providing after-hours pediatric health services, but probably not long enough to assess the full impact of after-hours health services on ED use. Further study, over an entire year allowing for the incorporation of both high and low seasonal trends will be essential to definitively assess if and HMO-FQHC collaboration on an after-hours clinic is an effective strategy to reduce ED visits in a traditionally underserved population of children covered under the Medicaid and SCHIP.

2 Handfuls of Medication in 2 Hours Just to Let Him Talk.

Repeated dose of adrenaline in anaphylaxis is limited evidence in clinical setting. Hence, the usage is depending on physician best interest and knowledge. We reported a case of repeated doses of adrenalin was given through nebulizer and intravenous in anaphylaxis. We believed the unusual circumstances of this case was likely to be repeated on some readers' clinical practice and this mode of treatment is an adjunct to consider in such cases especially in Emergency Department (ED).

Patient Satisfaction with Emergency Medical Services in Korea: What Matters Most?

PURPOSE: This study was performed to identify patient satisfaction with the emergency medical services (EMS) and its determinants. METHODS: Data were obtained from the first wave of the 2008 Korea Health Panel Survey. The unit of analysis was a case of patient visit of emergency department (ED) (n=1,280). Patient satisfaction with the EMS was categorized into two levels (1=satisfied, 2=dissatisfied). X2-test and logistic regression analysis were employed to find factors influencing the degree of EMS satisfaction. RESULTS: Among the 1,280 cases, 70.16% of patients were satisfied with the EMS. Patients who visited ED for accidents (odds ratio (OR)=1.42, p<0.05) were more satisfied with the services than those who visited ED for disease (reference). Also, patients who visited ED by private car (OR=3.05, p<0.05) or taxi (OR=4.00, p<0.05) or work (OR=4.78, p<0.01) showed higher satisfaction than those who visited ED by ambulance (reference) or 119 (OR=2.49, p<0.09). In addition, patients who experienced delay (reference) in ED admittance displayed lower satisfaction than those who did not (OR=2.06, p<0.001). Finally, patients who transferred to other hospitals (reference) after service completion indicated lower satisfaction than those who went back home (OR=4.04, p<0.0001) or were admitted (OR=5.69, p<0.0001). CONCLUSION: EMS policymakers should pay more attention not only to improve the quality level of ambulance or 119 service, but also to prevent ED delay.

Aortic Intramural Hematoma Diagnosed in the Emergency Department

PURPOSE: An aortic intramural hematoma (AIH) is a medical disease known to be a variant form of an aortic dissection without intimal tearing. Although it is not often encountered in the emergency department (ED), emergency physicians have to differentiate it from other aortic diseases or ischemic heart disease because the disease processes are similar and/or the symptoms, such as sudden chest pain, are the same. For that reason, we evaluated the clinical and radiological characteristics of AIH, as well as its treatment plans, complications, and follow-up results. METHODS: From 1995 to September 2002, a total of 30 patients were diagnosed with AIH by using computerized tomography (CT) in the Emergency Department, Yeungnam University Hospital. We reviewed the clinical charts and X-ray films retrospectively and evaluated the clinical features, the hospital courses, and the follow-up results. Also, we divided the patients into two groups according to the involvement of AIH : Stanford type A involved the ascending aorta and the aortic arch and accounted for 10 cases, whereas type B involved only the descending aorta and accounted for 20 cases. The data for the two groups were then compared. RESULTS: Of the 30 patients, the number of type B was twice that of type A. Of the 16 males in the study, 14 (88%) were type B. Almost all patients omplained of chest pain, back pain, or both, 80% had hypertension and 50% were smokers. Of the type A patients, 70% showed mediastinal widening on chest X-ray, which was confirmed by CT. According to the type of aortic wall thickness on CT, 50% were circular and 50% were crescentic. Complications included in 5 cases of pericardial effusion, of which 1 patient had a pericardial tamponade. Each 1 of these 5 patients progressed to aortic dissection and aortic rupture, after which they died. All patients except one took medical therapy, 2/3 of whom were followed up within at least one year. CONCLUSION: AIH is not a very common disease, but is often encountered in the ED. It 's a medical, not a surgical disease, but requires surgical therapy in cases of ascending aortic dissection or cardiac tamponade, and aortic rupture. Almost all patients with AIH can be diagnosed by emergency physicians using computerized tomography in the ED, so we think that it is very important to assess the patient's clinical status and complications, to monitor the patient carefully in the ED, and to make plans for follow-up.

Clinical Presentation of th patients with Non-traumatic Chest Pain in Emergency Department / 영남의대학술지

BACKGROUND: Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were 1.1+/-0.9 in non-cardiac diseases, 1.4+/-1.1 in cardiac diseases and 1.7+/-1.1 in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. CONCLUSION: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.