Comportamiento de un servicio de urgencias según el día de la semana y el número de visitas / Impact of the day of the week and the daily census on the emergency room performance

Objetivo: Determinar la relación que tienen el día de la semana y el número de visitas con los distintos marcadores de calidad de un servicio de urgencias hospitalario (SUH).Pacientes y método: Cuantificación diaria retrospectiva durante un período de 2 años del número de visitas, número de pacientes fallecidos, revisitas y número de pacientes fugados, así como del tiempo de espera para ser visitado y la estancia total en el SUH. Con las mediciones, se establecieron, según el día de la semana, 3 grupos: lunes, fines de semana y resto de días (días control). Los grupos se compararon entre sí y la relación entre variables se estudió por medio de regresión lineal múltiple. Resultados: Los lunes fueron los días de más visitas con 212 ± 18 vs201 ± 19 y 198 ± 19 de los fines de semana y controles respectivamente(p<0,001 para ambos). El porcentaje de fugados de los lunes (7,14 ± 4,48%) fue un 26,8% y un 11% superior al registrado los fines de semana (5,65 ± 3,77%) y días control (6,41 ± 4,24%) respectivamente. El tiempo de espera de los lunes (88 ± 37 min) fue un 17,3%y un 10% mayor al de los fines de semana (75 ± 38 min) y días control(80 ± 37 min) respectivamente. Se encontró una relación directa entre el número de visitas diarias y el porcentaje de pacientes fugados (..) (AU)

Aim: To assess the relationship between the day of the week and daily census and the quality markers in the emergency department(ED).Methods: For a 2-year period, daily measures of census, percentage of deaths, revisits, patients leaving without being seen (LWBS), waiting time and length of stay (LOS) were retrospectively obtained and compared according to the day of the week. Three groups were established: Mondays, weekend days, and weekdays (control group). The relationship among groups and among markers was assessed by multiple regressionanalysis. Results: Mondays showed the highest rate of visits (212 ± 18 vs201 ± 19 for weekend days and 198 ± 19 for control days; p < 0.001).LWBS was 26.8% and 26.8% higher on Mondays (7.14 ± 4.48) compared to weekend days (5.65 ± 3.77) and control days (6.41 ± 4.24) .Waiting time registered a significant increase on Mondays (88 ± 37min) compared to weekend days (75 ± 38 min, 17.3%) and control days (80 ± 37 min, 10%). A direct association between daily census and percentage of LWBS (r = 0.089) and waiting time (r = 0.106) was found. Conclusions: ED census is directly associated with the waiting time and the LWBS rates which are significantly higher in Mondays. This data may help to resolve several staff and overcrowding troubles in the EDs (AU)

Postpericardiotomy syndrome following minimally invasive coronary artery bypass.

A 62-year-old woman presented to the Emergency Department (ED) with chest pain, cough, subjective fever and chills. Symptoms had begun on the previous evening, three days after minimally invasive coronary artery bypass surgery (MICAB). A presumptive diagnosis of postpericardiotomy syndrome (postcardiac injury syndrome) was made and the patient admitted. This new, minimally invasive surgery allows discharge on the second postoperative day. Emergency physicians should be aware of this procedure since probably there will be increasing performance of MICAB procedures and patients will present to the ED with postoperative complications.

Thrombophlebitis and pseudothrombophlebitis in the ED.

The patient presenting to the emergency department (ED) with a painful swollen lower extremity is considered to have deep venous thrombosis (DVT) until this diagnosis can be ruled out. This clinical presentation, however, is far from specific and the differential diagnosis includes symptomatic Baker's cyst, also known as pseudothrombophlebitis syndrome (PTP). This article presents two cases of PTP and reviews the literature relevant to diagnosis of DVT and PTP. Ultrasonography is now the diagnostic test of choice for both DVT and PTP, being safe, accurate, noninvasive, and rapid, and should ideally be available for use in the ED.

Primary non-Hodgkin's lymphoma of the cranial vault.

We present a case of primary B-cell, large-cell, lymphoma of the skull vault in a 50-year-old HIV-positive male, who presented with a history of unilateral headache and a swelling on the scalp. Primary non-Hodgkin's lymphoma of the skull is rare, with only ten such cases in adults previously described. We suggest that this is the second reported case in an HIV-positive individual.

Transient Campylobacter bacteremia in a healthy child.

A 7-month-old immunocompetent child was brought to the emergency department with fever and diarrhea. Blood and stool cultures grew Campylobacter species. Campylobacter bacteremia resolved without treatment.

Hyperkalemia and digoxin toxicity in a patient with kidney failure.

Hyperkalemia resulting from digoxin toxicity is a well-recognized phenomenon. We report a case in which hyperkalemia, bradycardia, and hypotension were unresponsive to standard therapy but appeared to respond to digoxin-specific antibodies (Fab). This case highlights the importance of a high index of suspicion for digoxin toxicity as a potential cause of refractory hyperkalemia.

Spontaneous temporomandibular joint dislocation in an 80-year-old man.

We report the case of an 80-year-old patient who suffered a spontaneous temporomandibular joint (TMJ) dislocation. To our knowledge, this is the oldest patient reported to have this condition in the English-language literature. Reduction of spontaneous jaw dislocation is a procedure that usually can be accomplished in the office without intravenous sedation by properly applying downward pressure on the mandible.

Alkaline chemical keratitis: eye injury from airbags.

Inflation of an automobile airbag is accomplished by converting sodium azide to nitrogen gas. The bags are vented so that nitrogen and residual byproducts of combustion, such as alkaline gas, are released into the passenger compartment. We report the case of a patient who incurred a chemical keratitis after the driver's-side airbag deployed. The importance of recognition and management is discussed.