Reduced noise in the emergency department: the impact on staff well-being and room acoustics.

BACKGROUND AND INTRODUCTION: The ED is often perceived as noisy. Excessive noise has deleterious effects on health and productivity. This study evaluated if a package of noise-reducing interventions altered workload, physical complaints, productivity and room acoustics. METHODS: This was an observational pre-post implementation study. It was performed in our non-academic ED in the Netherlands from July 2021 to April 2022. Our primary objective was to determine if a combination of technical, acoustical and behavioural interventions was associated with improved staff well-being, and the secondary objective was to evaluate if these interventions resulted in better room acoustics. Moreover, the correlation of noise sensitivity with staff well-being and its effect on interventions were evaluated. All ED staff that were sufficiently exposed to the interventions received questionnaires to assess their well-being before and after the interventions. Room acoustics before and after interventions were expressed in reverberation time (seconds) and participant ratings are reflected as the mean of the sum of their Likert scale ratings. RESULTS: 43 participants were included. At baseline, individual noise sensitivity was significantly correlated with physical complaints (r=0.409, p=0.006) and productivity (r=0.399, p=0.008). After the interventions, a reduction in reverberation time was reached in the central ED area (0.49 s, SD 0.06 s vs 0.39 s, SD 0.05; p<0.001). Participants experienced significantly less noise disturbance during work (sum score 7.28 vs 3.19; p<0.001). Productivity and physical complaints improved significantly (sum score 4.81 vs 2.70; p<0.001 and sum score -3.74 vs -8.14; p<0.001, respectively). Participants also showed a perceived change in behaviour (sum score -2.00 vs -4.70; p<0.001). There was no confounding by noise sensitivity nor age. CONCLUSION: The package of behavioural, acoustical and technical interventions was associated with increased staff well-being, reflected by decreased perception of noise, increased productivity, decreased physical complaints and observable changes in behaviour. Furthermore, the interventions positively influenced the room acoustics.

Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study.

BACKGROUND: The onset of the COVID-19 pandemic was characterized by rapid increases in Emergency department (ED) patient visits. EDs required an appropriate transformation. The main challenges were: adapting capacity to respond to surges in the number of patient visits, protection of high risk (frontline) staff and the segregation of suspect-COVID-19 patients. To date, only a few studies have assessed the nation-wide response of EDs to the COVID-19 pandemic. This study was designed to review the preparations of Dutch EDs during the initial phase of this public health crisis. METHODS: The study was designed as a nation-wide, cross-sectional, questionnaire-based study of Dutch hospital organizations having one or more EDs. One respondent completed the questionnaire for each hospital. The questionnaire was conducted between the first and the second COVID-19 wave in the Netherlands. It contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in each hospital crisis management team. RESULTS: The questionnaire was completed by 58 respondents. This represented 80% of the total number of EDs. All respondents had made preparations in anticipation of a COVID-19 patient surge. Treatment capacity was expanded in 70% of EDs, with a median increase of 49% (IQR 33-73%). Suspect-COVID-19 was segregated from non-COVID-19 patients in 89% of EDs. Alternative locations (such as outpatient departments) were more often used to assess non-COVID-19 patients, than for suspect-COVID-19 patients. Staff was expanded in 82% of EDs. This largely concerned nursing staff. A formal role for Emergency Physicians (EPs) in the hospital's crisis management team was reported by 94% of hospital organizations employing EPs. CONCLUSION: All Dutch EDs responded to the COVID-19 pandemic in a very short time span despite much uncertainty. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs played a prominent role, both in direct COVID-19 care and in the hospital crises management team. It is vital for EDs to adapt to community needs swiftly. The ability of EDs to respond to the pandemic varied considerably.

[Kounis syndrome, the allergic acute coronary syndrome]. / Kounis-syndroom.

BACKGROUND: The occurrence of acute ischaemia or myocardial infarction in a patient experiencing an allergic reaction is known as allergic acute coronary syndrome or Kounis syndrome. CASE DESCRIPTION: A 63-year-old male had a postoperative anaphylactic reaction to an intravenous dose of diclofenac. Myocardial ischaemia occurred during treatment of the anaphylaxis, caused by spasm of the right coronary artery followed by occlusion of the left anterior descending artery (the ramus interventricularis anterior). Despite percutaneous coronary intervention, he suffered an infarct of the anterior myocardium, resulting in reduced left ventricular function. CONCLUSION: In patients with Kounis syndrome therapy should focus on both the allergy and the acute coronary syndrome. Early recognition and intervention have a great effect on prognosis.