Application of the triage and acuity scale in the emergency department of stomatological hospital / 口腔疾病防治

Objective@#This study aims to explore the effect of practice on the triage and acuity scale in the emergency department of Stomatological Hospital. @*Methods @#150 emergency patients admitted to the emergency department from April 2016 to July 2016 were randomly selected as the control group before the implementation of graded district diagnosis and treatment, and 150 emergency patients admitted from August 2016 to November 2016 were selected as the observation group after the implementation of graded diagnosis and treatment. The control group was treated with the traditional nursing treatment mode, and the observation group adopted the triage and acuity scale mode. The efficiency of treatment for the patients and the degree of satisfaction of the patients in terms of the nursing work was compared between the two groups (waiting time, checkup time, start treatment time). @*Results@#A comparison of the patients in the observation group and control group showed that the waiting time (min)(25.63 ± 8.75 vs. 35.57 ± 10.60, t = -8.52, P < 0.001), the time of accepting examination (min)(24.80 ± 7.90 vs. 39.23 ± 12.42, t = -12.01, P < 0.001) and the starting time of treatment （min）(28.67 ± 9.37 vs. 40.47 ± 10.86, t = -10.08, P < 0.001) were significantly lower in the observation group than the control group (P < 0.05). The degree of satisfaction with the nursing work for the patients in the observation group (96.67%) was higher than that of the control group (85.33%), and this difference was statistically significant (χ2=17.647, P=0.001). @*Conclusion@#The application of a triage and acuity scale in the diagnosis and treatment of stomatological emergency patients according to the severity and urgency of disease can ensure the priority of treatment in critically ill patients, the safe and efficient performance of emergency work, and improvements to the efficiency and quality of emergency medical services.

The establishment of pre-hospital and in-hospital first aid rapid linkage treatment platform of emergency patients / 中国实用护理杂志

Objective To establish a pre-hospital and in-hospital first aid rapid linkage treatment platform in order to provide quick rescue time for emergency patients. Methods The interconnection first aid APP was made.The emergency center and traffic command center were combined to participate in first aid. The traffic command center controls the traffic lights in real time to provide the optimal transportation path for the emergency patients.The first aid center carries out preliminary treatment,and shares the patient information to the hospital in real time to make the most suitable doctors waiting for the consultation. The therapeutic effects of patients with acute critical disease before and after the platform applied was compared. Results It has realized the tripartite information linkage between the hospital, the emergency center and the traffic command center. In the experimental group, the pre-hospital emergency response time,the hospital rescue time and the emergency success rate were(16.28±3.08)min, (17.89±5.84)min,87.85%(217/247),the control groups'pre-hospital emergency response time,the rescue time in hospital and the success rate of acute critical patients were(18.29±1.87)min,(24.84±1.69)min, 63.01% (138/219), the data of two groups were statistically significant (t=3.783, 5.745, χ2=5.404, P<0.05). Conclusions The establishment of pre-hospital and in-hospital first aid rapid linkage treatment platform of emergency patients can optimize the patient first aid survival chain, provide greater rescue opportunities for emergency patients.

Present situation about the medical resources used for emergency patients with medical insurance in China based on analysis of large numbers of data / 中华急诊医学杂志

Objective To investigate the current status and features of the use of medical resources for emergency patients with medical insurance in China clarified by analysis of large numbers of data.Methods Using the database from China Medical Insurance Research Association's research group,the total amount and the average cost of emergency medicines for patients with medical insurance,as well as the proportion of emergency medicines in total medical resources used in the emergency department were statistically analyzed.Additional analyses were made based on cities and medical institutions of different levels.Results The data were collected from more than 63 million pieces of medication information,from which 260 thousand pieces of information involved in emergency medicine used within 100 sorts of emergency medicines.The use of emergency medicines for emergency cases accounted for a low proportion of over all medicine used in emergency department in our country,and the specifications of emergency medicine were limited in a few kinds of medicine such as tetanus antitoxin injectio (1500 U),50％ glucose solution in 20 ml water,and 50 g mannitol in 250 ml water frequently used as the leading essential agents.The sum of consumption of emergency medicines in tertiary hospitals was the highest among all levels of medical institutions,and the proportion of which in all medicine used in the emergency department also in the first place of the list.In the third-tier cities,although the sum of consumption of emergency medicines accounted for a small proportion of the whole country,the proportion of which in all kinds of medicine used in the emergency department was highest,while the situation of first-tier cities was just on the contrary.Except for only a few medicines,the ranking of the use of any emergency medicine else varied little in different cities and in various medical institutions.Conclusions On one hand,the current status and characteristics of the use of emergency medicines for emergency patients with medical insurance in China may be related to the characteristics of emergency departments and emergency cases,and on the other hand,they could also be influenced by medicines in clinical needs,clinical compliance,and shortages.This study showed the clinical application of emergency medicines in China in the past three years,which can provide some clinical data for the revision of emergency drug list in the future.

Key factors affecting the correlation between improving work efficiency and emergency department overcrowding in the tertiary level A hospitals / 中华急诊医学杂志

Objective To investigate the current status of overcrowding in emergency departments of Tertiary level A hospitals in order to discover and analyze key factors limiting the performance efficiency of staff to raise a suggestion of improvements.Methods The data regarding the distribution of the total number of available beds and total number of patients registered were collected from 19 tertiary level A hospitals to construct a regression model correlating variables including number of patients waiting,time of appointment and number of patients delivered by ambulances.The national grading system of crowdedness for emergency departments was used to estimate the NEDOCS_ BJ value for Beijing Friendship Hospital.Results Statistical analyses of key factors hampering the work efficiency and correlation between ESI triage and clinical decisions revealed overcrowding in the emergency department in a pattern across hospitals and time periods.The extent of overcrowding can be alleviated by way of increase in performance efficiency.Conclusions The proposed improvements regarding the hierarchical medical system,the development of treatment plans,and working procedure were recommended.

Analysis and corresponding strategy of emergency patients forgoing the invasive rescue therapy / 中华急诊医学杂志

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

A Clinical Study On The Dental Emergency Patients Visiting Wonkwang Univ-Hospital Emergency Room

Analysis of Hypokalemia in Emergency Patients / 대한신장학회잡지

OBJECTIVES: Hypokalemia is one of the most common electrolyte disorders encountered in clinical medicine. It is important electrolyte disorder because it is account for neuromuscular, cardiovascular and renal disturbance. But there are few studies to evaluate the incidence and cause of hypokalemia in emergency patients. Present study was performed to evaluate the incidence and cause of hypokalemia and coincidental changes of other electrolyte and chemical parameters of blood and urine. METHODS: Hypokalemia was defined as a serum potassium concentration less than 3.5mEq/L. A total 80 medical patient without renal failure were prospectively studied for 62 days. Electrolytes and chemical parameters of the blood and urine were determined at emergency room. RESULTS: 1) Of medical inpatients through emergency room, hypokalemia was detected in high frequency(32%) and mild degree(mean; 3.1+/-0.1mEq/L). 2) The most common cause of hypokalemia was diuretics(23%), other causes were vomiting, SIADH, diarrhea, alkalemia, and unidentified cause(each; 15.4%). 3) Compared to the normokalemic group, the hypokalemic group showed significant decrease in urinary anion gap(P=0.003). 4) There was no significant difference of spot urine potassium concentrations between renal and extrarenal origin of hypokalemia. CONCLUSION: The hypokalemia in emergency patients was detected in high frequency and mild degree. Urine anion gap was significantly decreased in hypokalemic group than normokalemic group. Spot urine potassium concentration was less effective in differentiation of renal and extrarenal origin of hypokalemia.

A Statistical analysis of Dermatologic Emergency Patients Visiting the Emergency Room over 10 Years (1986 - 1995) / 대한피부과학회지

BACKGROUND: Dermatologic emergency patients who visit the emergency room increase in number every year. But there is no report about the statistical analysis of such visits. OBJECTIVES & METHODS: We reviewed 326 new dermatologic emergency patients who uisited the emergency room of Dongsan Medical Center in Taegu from 1986 to 1995 to study the age, sex, monthly and yearly distributior, arrival time, length of visit, prevalence of common dermatoses, admission rate and death rate. RESULTS: The results are summarized as follows: 1. Of 326 patients, there were 151 males and 175 females. The sex ratio of male to female was 1: 1.15. The number of patients increased with each year. 2. In age distribution, there were 23(7%) under 10;46(14%) between 11-20,55(17%) between 21-30;49(15% ) between 31-40;33(10%) between 41 50; 62(19% ) between 51-60 years,39(12% ) between 61-70 and 19(6%) between 71-80 years. 3. In monthly and arrival time distribution, the peak month incidence occurred in August(24 %), and the lowest incidence in December(1%). The peak incidence of arrival time occurred PM 6-12 hours and the lowest incidence AM 0-6 hour. 4. In the distribution about length nf visit, 73% of patients stayed more than 10 hours, 23% 5-10 hours and 4% less than 5 hours. 5. Of the most common derrnatoses, acute urticaria was seen in 124 cases(38%), and herpes zoster. in 94 cases (29%). In age distribution, acute urticaria was most preualent between the age of 0-30 and herpes zoster between 50-70. 6. The admission rate was 43%(140 cases). The death rate was 1.2%(3 cases). CONCLUSION: Our study of e nergency patients revealed that dermatologic emergency patients who visited the emergency room had increased in number every year and the distribution of patients is quite different from that of outpatients.

Statistical studies on pediatric emergency room patients

No abstract available.