Screening for pulmonary tuberculosis in Teresópolis, RJ, Brazil: the search for respiratory symptomatic patients in emergency service of "Hospital das Clínicas de Teresópolis Costantino Ottaviano, Fundação Educacional Serra dos Órgãos"

The aim of the present study was to investigate the detection percentage of tuberculosis among patients that are respiratory symptomatic (TB suspects). In this work, we present the preliminary results of research carried out at "Hospital das Clínicas de Teresópolis Costantino Ottaviano da Fundação Educacional Serra dos Órgãos (FESO)" from November 2003 to April 2004. Among the 40 respiratory symptomatic individuals identified and referred to the Tuberculosis Control Program in Teresópolis, two (5.0%) were characterized as smear-positive. These results confirm reports in the literature and underscore the need for and importance of this strategy.

On an organizational level: How can the emergency department at Rouge Valley Centenary hospital improve their wait times?

The prolonged wait times may arguably put into question the Canadian Health Act of 1984. Statistics show throughput wait times are 5.5 hours and output wait times for admitted patients are 32.4 hours. After probing and analyzing best practices through a qualitative/quantitative Value Stream Mapping and a qualitative SWOT Analysis; Team Triage and an Overcapacity Protocol is suggested to improve non-admitted patients wait times by 1.89 hours and admitted patients wait times by 16 hours by eliminating wasteful steps in the patient process and upon overcapacity, effectively sharing already stabilized and admitted patients with all wards in the hospital.

Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital.

BACKGROUND: Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65-84 years during this period and to investigate the evolution of these comparisons over time. METHODS: Data considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated. RESULTS: Between 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65-84 years. Compared to patients aged 65-84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010. CONCLUSIONS: Oldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients.

Acute Hospital Portfolio - Accicent & Emergency in Northern Ireland Regional Summary (PDF 80 KB)

October 2003 - main findings arising from the study and the key conclusions

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study.

OBJECTIVE: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). DESIGN: Controlled longitudinal study. SETTING: English National Health Service between 1998/99 and 2010/11. PARTICIPANTS: Populations registered with each of 6975 family practices in England. MAIN OUTCOME MEASURES: Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. RESULTS: Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. CONCLUSIONS: The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities.

Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

Nursing staff sizing in the emergency room of a university hospital

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

Emergency Department use by patients aged 85 years and over, between 2005 and 2010 in a Swiss university hospital

Introduction: Population ageing challenges Emergency Departments (ED) with a population shift toward higher age groups. People over 65 years are heterogenous with respect to polymorbidity and functional capacity. Complex situations become more prevalent among patients aged 85+, the fastest growing segment of the elderly population (+72% between 2010 and 2030). Objectives: To identify the trend of ED admission rates for patients aged 85+ and to compare the characteristics of their ED visits with the one of patients aged 65-84. Method: Retrospective analysis of 56162 ED admissions of patients aged 65+ at the University of Lausanne Medical Center (CHUV), from 2005 to 2010. All visits of patients aged 65+ at the time of admission were considered. Analyses focus on demographic characteristics, living arrangement, hospital admission, and median Length of Stay (LOS) in the ED. Data from 2010 were examined for the degree of emergency (DE), the main reason for visiting the ED (Swiss triage scale) and readmission at 30 days. Results: Between 2005 and 2010, ED visits of patients aged 65 years and over increased from 8228 to 10390/year (with a slight decrease of women from 56% to 54%). This is an increment of +26% i.e. 5.9 patients/day more. Patients aged 85+ increased by +46% vs +20% for the 65-84. ED visits of people aged 18-64 years raised by +20%. Among patients over 65 years, the proportion of patients aged 85 and more increased from 23% in 2005 to 27% in 2010. In 2010, 85+ patients were more likely than 65-84 patients to come from a NH setting (13% vs 4%), to be hospitalised (70% vs 59%) and to stay longer in the ED (median LOS 9 hours vs 7 hours). Readmission to ED within 30 days after discharge did not differ (85+: 14% vs 65-84: 12%) (similar proportions in 2005). In 2010, the first reason for patients 85+ to visit ED was fall/injury (27% vs 18% by 65-84), whereas the main cause for patients aged 65-84 years was a cardiovascular disorder (18% vs 16% by 85+). The part of high emergency cases was similar for patients 85+ and 65-84 (42%). Conclusion: Among aged patients those aged 85 and over are the fastest growing group admitted to ED. Compared to their younger counterparts, their reason to visit ED and their pattern of health services utilization differ due to specific epidemiological conditions. ED addressing specific needs of geriatric patients would improve their care and lead to a better use of available resources.

Emergency Department Use by oldest-old Patients Between 2005 And 2010 in a Swiss University Hospital

Introduction: Population ageing challenges Emergency Departments (ED) with a population shift toward higher age groups. Patients aged 85+, represent the fastest growing segment, leading to more prevalent complex situations within ED. Method: Retrospective analysis of 56'162 ED visits of patients at the University of Lausanne Medical Center (CHUV), from 2005 to 2010. Results: ED visits of 65+ patients increased from 8'228 to 10'390/year, representing 6 patients/day more (+26%). 85+ Patients increased by +46% vs +20% for the 65-84 (+20% ED visits of people 18-64y). Median age of the 65+ ED patients increased from 78.7 to 79.3 years. 85+ patients were more likely than 65-84y patients to come from a NH setting (13% vs 4%) and to be hospitalised (70% vs 59%). Median length of stay difference between both age groups extended from 2 hours 08 min in 2005 to 2 hours 45 min in 2010. First reason to visit ED was fall/injury for 85+ patients (27%; 65-84: 18%) and a cardiovascular disorder for patients aged 65-84y (18%; 85+: 16%). Part of high degree of emergency cases (42%) and readmission to ED within 30 days (8%) were similar for both age classes (similar proportions in 2005 and 2010 for these 3 issues). Conclusion: Patients aged 85+ are the fastest growing group admitted to ED. Compared to younger counterparts, they use more ED ressources and the differences are increaseing overtime. ED addressing specific needs of geriatric patients would improve their care and lead to a better use of available resources.

Emergency hospital services utilization in Lleida (Spain): a cross-sectional study of immigrant and Spanish-born populations

Background: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). Methods: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. Results: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. Conclusion: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Emergency department visits for non-life-threatening conditions : evolution over 13 years in a Swiss urban teaching hospital

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.