Correlation of blood gas parameters with central venous pressure in patients with septic shock; a pilot study

Objective: To determine the correlation between blood gas parameters and central venous pressure [CVP] in patients suffering from septic shock

Methods: Forty adult patients with diagnosis of septic shock who were admitted to the emergency department [ED] of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were

Results: A significant direct correlation between CVP with anion gap [AG] and inversely with base deficit [BD] and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/ AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index [SI] and mean arterial pressure [MAP]

Conclusion: It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock

Utilization of failure mode and effects analysis [FMEA] method in increasing the revenue of emergency department; a prospective cohort study

The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments [ED] are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis [FMEA] method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number [RPN], and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluat-ed during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1 +/- 3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED reve-nue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively [337.75% increase in two years] [p<0.001]. 111.0% increase in the ED revenue after solving of first priority problems revealed that they were extremely indispensable in decreasing the revenue [p<0.0001]. The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit, and lack of specific identifying code for the patients moving from ED to any other department, were the two first priority problems in decreasing our ED revenue

Emergency department performance indexes before and after establishment of emergency medicine

Emergency department performance index [EPI] greatly influences the function of other hospital's units and patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study the performance indexes of emergency department [ED] in one educational hospital has been assessed before and after establishment of emergency medicine. In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran was assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods of before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, left the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations [CPR], discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients' files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months [P=0.06]. The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% [P=0.004]. However, the percentage of disposed patients during 6-hour [P=0.2], unsuccessful CPR [P=0.34] and discharged against medical advice [P=0.42] did not differ between the two periods. It seems that establishment of emergency medicine could be able to improve ED performances indexes such as time to triage and leave in a 12-hour period