Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

To evaluate the effectiveness of a new patient flow system, 'The Red Box' on the quality of patient care in respect of the time taken for the care to be delivered to the patient. A pre-post study was conducted looking at the door-to-doctor [DTD] and door-to-analgesia [DTA] times for cases presenting to the Emergency Department [ED] of a tertiary teaching hospital 'The National University of Malaysia Medical Center' between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. A total of 1,000 cases were enrolled. Group A [pre-Red Box] and group B [post-Red Box] comprised 500 cases each. The mean DTD time for group A was 29 minutes [SD +/- 3 minutes] and for group B was 3 minutes [SD +/- 1 minute], with a 98.8% reduction [p<0.001]. For DTA time, group A recorded a mean of 46 minutes [SD +/- 3 minutes], and group B recorded a mean of 9 minutes [SD +/- 2 minutes], an 80.4% reduction [p<0.001]. The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time

Phenylpropanolamine-induced intraventricular hemorrhage.

Intracranial hemorrhage is an uncommon complication of phenylpropanolamine. There is an increasing awareness of this complication in the West. However, to the best of our knowledge there have been no cases reported from India. Here we report a patient who developed Intraventricular hemorrhage following ingestion of Phenylpropanolamine, from which he made an uneventul recovery over the next two weeks.

Effect of posture in immediate post-exercise period on ischaemic ST-changes during stress electrocardiographic testing.

In this study of stress testing, the posture in which patients were put had effect on heart rate, blood pressure, rate pressure product and ST-segment depression integral in the recovery phase. The systolic blood pressure in recovery phase of stress testing fell more rapidly towards normal pre-exercise value in sitting (Group I) than in lying down (Group II) posture (p < 0.05) from 2nd to 5th minute. The changes in heart rate were less and slower in lying posture than with sitting up. The decrease in rate pressure product (RPP), a determinant of myocardial oxygen requirement was lower in lying down than in sitting up posture (p < 0.05) from 2nd to 5th minute of recovery. Consequently, ST-depression, a marker of ischaemia was more marked in lying down than sitting up. The ST-depression integral was 4.15 +/- 1.2 and 7.10 +/- 1.65 in 2nd minute in group I and group II respectively, and the difference was statistically significant in 2nd, 7th (p < 0.05) and 8th minute (p < 0.01) of recovery. These changes are important in interpretation of results of exercise testing.