Causes of access block and Emergency department overcrowding in Beijing: a two year study / 中华急诊医学杂志

Objective To study the causes of emergency department (ED) overcrowding and access block in Beijing.Methods This was a multi-center cross sectional study.The studied cohort of patients included all ED visiting patients from 18 municipal teaching hospital EDs in Beijing from 2012 to 2013.Patient' s characteristics and medical care settings were analyzed.Results The urgent care cases accounted for only 4.6 ％ (71 224/1 554 387) of the emergency annual visits in 2012 and 5.5 ％ (88 190/1 615 571) in 2013.The total number of observation patients in EDs was 185 277 and 211 900 in 2012 and 2013 respectively,with an increase of 14.4 ％ (P ＜ 0.01).The total ED-admission inpatients only accounted for 2.97％ and 2.89 ％ of total annual visits in 2012 and 2013 respectively.The average time of ED-admission took 37.1 hours and 36.2 hours in 2012 and 2013 respectively.The average time of ED stay for observation was 4.9 days and 5.4 days in 2012 and 2013 respectively.Upper respiratory tract infection was the leading illness in annual visits.The leading cause of ED stay for observation was bedridden with pneumonia.Conclusions The ED settings in Beijing are different from other countries.The EDs actually assume the task of the clinic and ED service for 24 hours thereby made EDs terribly overcrowded.The main causes are large number of non-emergency patients visiting the ED and patients in the ED are difficulty to be hospitalized.Patients with end-stage disease and multiple organ failure stayed in the ED due to nursing home shortage.

Detection of abnormalities in dyspneic patients using a new lung imaging modality / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although chest radiography is a useful examination tool, it has limitations. Because not all chest conditions can be detected on a radiograph, radiography cannot necessarily rule out all irregularities in the chest. Therefore, further imaging studies may be required to clarify the results of a chest radiograph, or to identify abnormalities that are not readily visible. The aim of this study was to compare traditional chest radiography with acoustic-based imaging (vibration response imaging) for the detection of lung abnormalities in patients with acute dyspnea.</p><p><b>METHODS</b>The current investigation was a pilot study. Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation. Dynamic and static images of vibration (breath sounds) and a dynamic image score were generated, and assessments were made using an evaluation form.</p><p><b>RESULTS</b>In healthy volunteer controls (n = 61), the mean dynamic image score was 6.3 ± 1.9. In dyspneic patients with normal chest radiographs (n = 51) and abnormal chest radiographs (n = 48), the dynamic image scores were 4.7 ± 2.7 and 5.1 ± 2.5, respectively (P < 0.05). The final assessment of the vibration images indicated abnormal findings in 15%, 86% and 90% of the participants in the above groups, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>In patients with acute dyspnea who present with normal chest radiographs, respiratory sound analyses often showed abnormal values. Hence, the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea.</p>

The impact of an algorithm of mandatory treatment of sepsis on the outcomes of patients suffering from severe sepsis and septic shock / 中华急诊医学杂志

Objective To study the impact of therapy strategy on outcomes of patients suffering from severe sepsis and/or septic shock. Method A total of 195 patients diagnosed as severe sepsis or septic shock were enrolled for prospective study from June 2008 to December 2009. Patient's clinical manifestation,treatments and outcomes were studied by using SSC database. Patients were divided into control group and treatment group. In control group, patients enrolled from June 2008 to December 2008, were treated with conventional medical care In treatment group, patients enrolled from January 2009 to December 2009 were treated with a novel algorithm of mandatory treatment for sepsis In-hospital mortality of two groups was compared. SPSS15.0 software was used for analysis of data. Chi-square test and unpaired t-test were used for comparisons between groups. Results Compared to the control group The need for blood lactate test was significantly grown in treatment group [98.2% (115/117) versus 2.56% (2/78), P ＜ 0.001]. Antibiotics was administered to 69.2% (81/117) patients of treatment group within 3 hours after their arrival at the emergency department compared to 35.8% (28/78) in the control group (P ＜ 0. 001). Blood cultures made before antibiotics given were 47.9% (56/117) in the treatment group compared to the control group 25.6%(20/78), P = 0. 003. The rate of fluid resuscitation was 80.3% (53/66) in the treatment group and 27%(10/37) in the control group, P ＜0.001. The rate of CVP (8 mmHg was 27.3% (18/66) in the treatment group and 8.1% (3/37) in the control group, P = 0. 023. In-hospital mortality was 29.1% (34/117) in the treatment group and 44.8% (35/78) in the control group, P =0. 032. Conclusions The algorithm of mandatory treatment for sepsis improved the therapeutic efficacy of the treatment for severe sepsis and septic shock, decreasing in-hospital mortality.