Logistics and outcome in urgent and emergency colorectal surgery.

AIM: Infrastructure-related factors are seldom described in detail in studies on outcome after surgical procedures. We studied patient, procedure, physician and infrastructure characteristics and their effect on outcome at a Norwegian University hospital. METHOD: All patients admitted between 1st January 2002 and 30th June 2003 who underwent urgent or emergency colorectal surgery were extracted from the hospital databases and retrospectively analysed. RESULTS: There were 196 patients. The overall complication rate was 39%. Forty-six (24%) patients died during admission after surgery. Those who died were less likely to be operated by a subspecialized colorectal surgeon (17%vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients who died were more likely to be operated upon at night (28%vs 18%, P = 0.001). The time interval standard from admission to surgery was met in only 84 (43%) patients. Forty-nine (49/196, 25%) procedures were delayed beyond the time requested by the surgeon by more than 120 min (mean 363 min). CONCLUSION: The outcome after emergency colorectal surgery was consistent with the literature but the infrastructure was not optimal. Improvements may be achieved by a focus on decreasing waiting times, abandoning of out-of-office emergency surgery and increasing the involvement of senior staff.

[Drug-related problems in an emergency department in the center of Amsterdam, June-November 2000]. / Drugsgerelateerde problemen op een afdeling Spoedeisende Hulp in het centrum van Amsterdam, juni-november 2000.

OBJECTIVE: To gain insight into the nature and magnitude of drug-related problems in the emergency department (ED) of a hospital (Onze Lieve Vrouwe Gasthuis) in Amsterdam, the Netherlands. DESIGN: Prospective, observational. METHOD: During the period from June through to November 2000, the following data were recorded for all patients visiting the ED with drug-related problems: age, sex, nationality, form of presentation, presenting complaint, drugs used, diagnostics performed, treatment in the ED and clinical course leaving the ED. RESULTS: During the study period, 214 (1%) patients were seen with drug-related problems. The largest group consisted mainly of young, foreign occasional users of soft drugs (117 patients, 55%). Their complaints were aspecific and harmless. The need for additional diagnostics was limited, with no additional diagnostic tests being carried out in 178 patients (83%). Treatment consisted of reassurance (50 patients, 23%), observation (123 patients, 58%) and medication (85 patients, 40%). Nineteen patients (9%) needed additional treatment (suturing, plastering, etc.). Ten patients (5%) were admitted to the hospital. Reasons for admission were psychotic episodes, prolonged unconsciousness or respiratory problems. CONCLUSION: The magnitude of the drug problem in an emergency department in the centre of Amsterdam and the use of medical resources were limited. The nature of the problem consisted mainly of mild symptoms following the use of soft drugs, usually by young, foreign occasional users.