Nurse-initiated radiographic-test protocol for ankle injuries: A randomized controlled trial.

INTRODUCTION: Nurse-initiated radiographic-test protocol was compared with usual practice in reducing unnecessary ankle and foot radiographic-test requests and shortening patients' length of stay (LOS) in an emergency department (ED) by reducing their waiting time for physician reassessment. METHODS: Patients with ankle injuries were enrolled in an unblinded randomized controlled trial. Participants were randomized to receive either the protocol (n = 56) or usual practice (n = 56). Primary outcome was the proportion of radiographic-test requests. Secondary outcomes were the proportion of fractures detected and patients' LOS and waiting times. RESULTS: The proportions of ankle and foot radiographic tests requested by triage nurses implementing the Ottawa Ankle Rules (OARs) in protocol group were smaller than those requested by physicians using their expertise in usual practice group. The proportions of malleolar and midfoot fractures detected by triage nurses implementing the OARs in protocol group were higher than those detected by physicians using their expertise in usual practice group. Patients' LOS and waiting time from consultation to discharge in protocol group were shorter than those in usual practice group. CONCLUSIONS: Implementing the nurse-initiated radiographic-test protocol reduced unnecessary ankle and foot radiographic-test requests and shortened patients' LOS in the ED by reducing their waiting time for physician reassessment.

Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study.

OBJECTIVES: To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. BACKGROUND: Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. METHODS: A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. RESULTS: No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. CONCLUSION: The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department.

Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments.

OBJECTIVE: This study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. METHODS: This study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. RESULTS: During the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27 days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13 days from the previous length of 5.16 days. CONCLUSIONS: EMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.

Geriatric consultation service in emergency department: how does it work?

BACKGROUND: Hong Kong is having a significant prevalence of geriatric patients who usually require admission after presentation to the hospital through emergency departments. The geriatric consultation programme 'We Care' aims at lowering acute geriatric medical admission. OBJECTIVES: The study aims at analysing the impact of the geriatric consultation service on the acute medical admission, and to study the characteristics and outcome of geriatric patients. METHODS: Retrospective study. Patients who received geriatric consultations during 1 January 2009 to 1 March 2011 were enrolled. The demographic information, diseases case mix, venue of discharge, clinical severity, community nursing service referrals and adverse outcomes were retrieved and analysed. The incidence of adverse outcomes under the presence of each factor was studied. RESULTS: 2202 geriatric patients were referred. Their age ranged from 45 to 99 (mean 79.91, SD 7.45, median 80). These cases were categorised into: (1) chronic pulmonary disease (n=673; 30.6%), (2) debilitating cardiac disease (n=526; 23.9%), (3) geriatric syndromes (n=147; 6.7%), (4) neurological problems (n=416; 18.9%), (5) diabetes-related problems (n=146; 6.6%), (6) terminal malignancy (n=39; 1.8%), (7) electrolyte or input/output disturbance (n=137; 6.2%), (8) non-respiratory infections (n=36, 1.6%) and (9) others (n=82; 3.7%). Acute medical admission was evaded in 84.7% of all consultations with 1039 (47.2%) patients discharged home and 825 patients (37.5%) admitted to convalescent hospital. The incidence rate of adverse outcomes was 1.6%. CONCLUSION: Programme 'We Care' provided comprehensive geriatric assessment to suitable geriatric patients, resulting in an effective reduction of acute geriatric hospital admission.

Measuring performance of night-time interfacility transport service.

The service reorganization is a part of the healthcare system reform. Some hospitals may not be able to provide all services in a 24-h basis. This evaluation was on all night-time (22 : 00 p.m. to 07 : 00 a.m.) interfacility transport by Alice Ho Miu Ling Hospital emergency department from January 2008 to December 2010, which were in-patients from nonemergency wards. The safety, speed, and performance were analyzed. During the study period, 73 cases were transferred out. Majority of them were having neurosurgical emergency (n=21, 29%) or surgical emergency (n=34, 46%). En-route physiological deteriorations were encountered in 4% (3/73) of cases. The mean acceptance time was 8 min and the team mobilization time was 13 min on average. The total service time ranged from 40 to 115 min. In conclusion, en-route adverse event was not rare. The specialized team can act as a facilitator and coordinator to improve the safety and effectiveness of the whole process.

Hazmat disaster preparedness in Hong Kong: what are the hazardous materials on Lantau, Lamma, and Hong Kong Islands?

OBJECTIVE: Hazmat disaster preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study describes the identities and quantities of hazardous materials (HMs) in Hong Kong and lists what antidotes are needed for these dangerous goods (DGs). This study describes what HMs are most common in Hong Kong to prioritize disaster preparedness and training. DESIGN: A descriptive, cross-sectional study. SETTING: The Hong Kong Special Administrative Region, specifically Lantau, Lamma, and Hong Kong Islands. SAMPLE: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). INTERVENTIONS: Descriptive statistical analyses with Stata 9.2. MAIN OUTCOME MEASURES: Identifying and quantifying HMs in the HKFSD DGD. RESULTS: Most HMs do not have antidotes. The most common HMs with recognized antidotes are carbon monoxide, methylene chloride, fluorides, cyanides, nitriles, hydrazine, methanol, and nitrates. The most common categories of DGs are substances giving off inflammable vapors, compressed gases, and corrosive and poisonous substances. CONCLUSIONS: Hazmat disaster preparedness and training should emphasize these most common categories of DGs. Disaster planning should ensure adequate antidotes for HMs with recognized antidotes, ie, oxygen for carbon monoxide and methylene chloride; calcium gluconate and calcium chloride for fluorides; hydroxocobalamin or amyl nitrite, sodium nitrite, and sodium thiosulfate for cyanides and nitriles; pyridoxine for hydrazine; fomepizole or ethanol for methanol; and methylene blue for methemoglobinemia produced by nitrates. Supportive care is essential for patients exposed to HMs because most DGs do not have antidotes.