[National developments in Emergency Departments in the Netherlands: numbers and origins of patients in the period from 2012 to 2015]. / Landelijke ontwikkelingen in de Nederlandse SEH's.

OBJECTIVE: Gaining insight into key figures of emergency departments (EDs) in the Netherlands and developments in these figures. DESIGN: Longitudinal survey study. METHOD: Over the period from 2012 up to and including 2015, the following key data were surveyed: number of EDs, number of ED patients, ED patients' origin, number of hospital admissions from the ED and form of cooperation between ED and a general practitioner centre (GPC). RESULTS: An average of 96% of all EDs responded. The number of EDs decreased from 93 to 87. The percentage of EDs that maintained a form of cooperation with a GPC in the hospital rose from 49% to 79%. The total number of patients seen annually in an ED in the Netherlands decreased by 128,000 to 1.951 million. The proportion of patients presenting in the ED via ambulance, mobile medical team or 112 (emergency number) increased by 2.6% to 16.0%. The proportion of patients referred from their own GP or GPCs increased by 7.8% to an average of 50.3%. The proportion of self-referrals decreased by 12.6% to 17.4%. The proportion of patients who came up to the ED through a different route remained constant at around 14%. The nationwide variation in the origin of patients remained high. The average percentage of hospital admissions from the ED increased by 5.6% to 37.2%. CONCLUSION: The number of EDs is decreasing and the cooperation between EDs and GPCs has intensified. The number of patients seen in the ED has decreased. The percentage of self-referrals has decreased and the number of hospital admissions from the ED has increased significantly. For a successful and consistent policy, more substantive data on the nature and extent of emergency care in the ED are needed. This requires a national registry.

Diving accidents: a cohort study from the Netherlands.

BACKGROUND: Diving is, besides professional reasons, an increasingly popular leisure activity. Whilst statistically compared to other sports safe, diving accidents can result in serious complications. In order to treat this specific patient category adequately, early diagnosis is important. In this study, we explore various medical aspects of diving accidents. By sharing our experiences, we intend to create awareness and enhance urgent medical care for this specific category of patients. METHODS: We conducted a retrospective cohort study using anonymized patient records from the emergency department (ED) of the Admiraal De Ruyter Hospital (ADRZ) and affiliated Medical Centre Hyperbaric Oxygen Therapy (MCHZ1) both in Goes, Netherlands. We evaluated all patients that presented to our ED as a diving accident from 1 November 2011 to 30 August 2015. RESULTS: In the selected period, 43 patients presented to our ED with complaints after diving; 84 % were male and 49 % older than 40 years, and they came by ambulance or referred by a general practitioner or other medical centres in the area; 70 % presented the same date as their dive, 21 % 1 to 3 days and 9 % later than 3 days after having dived. Pain was the most frequently reported symptom (44 %), followed by constitutional symptoms (42 %). Numbness or paraesthesia was reported in 33 %. Respiratory symptoms, dizziness, a change in mental status (e.g. apathy, confused or restlessness) and problems with coordination were present in 10-21 % of the cases. Symptoms that were apparent in less than 10 % of the cases were cutis marmorata, visual or auditory complaints, muscle weakness, cardiovascular symptoms or a malfunction of the anal sphincter or urinary bladder. Most of our patients exhibited more than one symptom; 70 % of all patients received hyperbaric oxygen recompression therapy. CONCLUSIONS: The limited number of patients presenting with complaints after a diving incident, the difficulty of recognition and the (potential) huge impact if not recognized and treated adequately make us believe that every diving accident should be discussed with a centre of expertise.