Family presence in emergency: Attitude and belief among emergency health professionals in a Tertiary Care Hospital of Nepal

Background: The emergency department of B.P Koirala Institute of Health Sciences, Dharan, a 700 bedded tertiary care centre provides all medical and surgical services, with easy access to patients by their family members during most of the resuscitation procedures. Complete privacy hence is not ideally maintained. Coping with emotional stress among the family members can be a gruesome experience and reactions from them can be unpredictable. Hence, health professionals are usually exposed to various emotions of the family members of these sick patients.Methods: It is a descriptive cross sectional study among the health professionals working in the emergency department. A sample size of 80 is taken over a period of 3 months. A semi-structured questionnaire leaflet was distributed and collected by the researcher. The attitude and belief was evaluated by 12 questions on the 5 point Liker scale and cutoff value being 3. Points less than 36 were given as negative attitude towards the family presence and more being positive.Results: Out of 80samples, 75 completed with a response rate of about 94%. The majority belonged to age group 20-29 years (70.7%) age, among profession Nurses respondents were about 56%. Male and Female respondent were about equal in numbers, qualification with undergraduate level was higher (73.3%), with an experience of less than 1year being 40%. Amongst the responders there is a positive attitude with increasing age, experience and qualification.Conclusion: The health professionals had a negative attitude towards the presence of family members during the resuscitation or invasive procedures. Hence with the ethnicity and cultural aspect of family their presence is well accepted. Health Renaissance 2015;13 (3): 152-160

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Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.746 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s203-s204

Author(s):

Rozina Roshanali

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Limited Resource ◽

Multidrug Resistant ◽

Communicable Diseases ◽

Care Hospital ◽

Middle Income ◽

Safe Patient Care ◽

Bed Management ◽

Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

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Strategies to increase compliance with out-patient aftercare among patients referred to a psychiatric emergency department: a multi-centre controlled intervention study

Psychological Medicine ◽

10.1017/s0033291798006825 ◽

1998 ◽

Vol 28 (4) ◽

pp. 949-956 ◽

Cited By ~ 20

Author(s):

D. SPOOREN ◽

C. VAN HEERINGEN ◽

C. JANNES

Keyword(s):

Emergency Department ◽

Treatment Compliance ◽

Psychiatric Emergency ◽

Family Presence ◽

Experimental Procedure ◽

The Third ◽

Randomized Controlled ◽

The Family ◽

Referral Compliance ◽

Motivational Counselling

Background. Compliance with referral for out-patient aftercare of psychiatric emergency patients is limited. This study investigated the efficacy of a combination of several referral strategies (fixed appointment, involvement of the family, presence of the aftercare person, motivational counselling) in increasing referral and treatment compliance of patients referred to the psychiatric emergency department of three general hospitals.Methods. A randomized controlled design was used to assess the effect of this experimental condition on referral compliance and on continuation of aftercare treatment.Results. A significant beneficial effect on compliance with the referral was found in two hospitals and a near-significant effect in the third. After 3 months of aftercare, the influence of the experimental procedure on adherence to therapy was still significant in two hospitals, but not in the third.Conclusions. Helping the patient to attend an initial appointment can be achieved by a combination of practical and organizational arrangements.

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Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽

10.1161/circ.142.suppl_3.14721 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ghufran adnan ◽

Osman Faheem ◽

Maria Khan ◽

Pirbhat Shams ◽

Jamshed Ali

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Reduction Rate ◽

Care Hospital ◽

Chi Square ◽

Coronary Syndrome ◽

Significant Difference ◽

Drastic Increase ◽

Chi Square Test ◽

The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

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VALIDATION OF QUICK COVID SEVERITY INDEX IN COVID PATIENTS ADMITTED THROUGH EMERGENCY DEPARTMENT OF A PRIVATE TERTIARY CARE HOSPITAL IN WEST BENGAL, INDIA

10.36106/ijsr/7821858 ◽

2021 ◽

pp. 53-55

Author(s):

Harsimran Singh Das

Keyword(s):

Emergency Department ◽

Respiratory Failure ◽

Tertiary Care Hospital ◽

Clinical Status ◽

Tertiary Care ◽

Severity Index ◽

Adult Patients ◽

Care Hospital ◽

Oxygen Requirement ◽

Clinical Tool

Introduction:qCSI (Quick COVID severity index) is a clinical tool established recently post pandemic to predict respiratory failure within 24 hours of admission in COVID-19 patients; respiratory failure being explain as increased oxygen requirement greater than 6L/min by low ow device, high ow device, noninvasive or invasive ventilation to maintain spO2 of greater than or equal to 94%, or death. Aim:To verify and validate the application of the qCSI in Emergency Department in Indian demographic for evidence-based guidance to aid physician decision making in safely dispositioning adult patients with COVID-19 with oxygen requirement less than or equal to 6L/min via low ow devices including nasal cannula and oxygen mask Materials and methods:This is an observational, retrospective study from Emergency Department in a private tertiary care hospital of admitted adult patients with COVID-19 disease. Clinical parameters in qCSI and disposition of 210 patients admitted through Emergency Department included in this study selected randomly was sought on admission and clinical status with level of care 24 hours following admission was recorded and compared with prediction based on qCSI from a period of 1 May 2020 to 31 October 2020. Result:We found that19(9.0%) patients Initial qCSI Score was Low, 80(38.1%) patients Initial qCSI Score was Low-intermediate, 84(40.0%) patients Initial qCSI Score was High-intermediate and 27(12.9%)patients Initial qCSI Score was High.qCSI Score after 24 hours 16(11.4%) patients were Low, 43(30.7%) patients were Low-intermediate, 63(45.0%) patients was High-intermediate and 18(12.9%) patients was High.Out of 210(100.0%) patients, 70 (33.3%) patients were critically ill. Conclusion:In conclusion these data show that the quick COVID-19 Severity Index provides easily accessed risk stratication relevant to Emergency Department provider.

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Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

10.21203/rs.3.rs-820832/v1 ◽

2021 ◽

Author(s):

Seema Sachdeva seema sachdeva ◽

Akshay Kumar Akshay Kumar ◽

Parveen Aggarwal Parveen Aggarwal

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Signs And Symptoms ◽

Fish Bone ◽

Quality Improvement Initiative ◽

Care Hospital ◽

Analysis Model ◽

Post Intervention ◽

Targeted Interventions ◽

Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

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Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

10.22514/sv.2021.040 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Rating Scale ◽

Rescue Therapy ◽

Tertiary Care ◽

Numeric Rating Scale ◽

Controlled Study ◽

Care Hospital ◽

Acute Migraine ◽

Pain Scores ◽

Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

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Validation of instruments about family presence on invasive procedures and cardiopulmonary resuscitation in pediatrics

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.2368.3046 ◽

2018 ◽

Vol 26 (0) ◽

Author(s):

Cristiana Araújo Guiller Ferreira ◽

Flávia Simphronio Balbino ◽

Maria Magda Ferreira Gomes Balieiro ◽

Myriam Aparecida Mandetta

Keyword(s):

Cardiopulmonary Resuscitation ◽

Professional Practice ◽

Health Professionals ◽

Family Care ◽

University Hospital ◽

Invasive Procedures ◽

Family Presence ◽

The Family ◽

Good Internal Consistency

ABSTRACT Objective: to develop and validate instruments to identify health professionals’ beliefs related to the presence of the child’s family in invasive procedures and in cardiopulmonary resuscitation. Method: study based on Psychometrics to conduct the theoretical, empirical and analytical stages, developed in a neonatal unit of a university hospital. The two instruments were constructed based on the literature and applied to 96 health professionals. Results: the Cronbach’s Alpha of the instrument related to the professionals’ beliefson invasive procedures was 0.863 and the instrument on cardiopulmonary resuscitation was 0.882. In both instruments, the tests performed indicated a correlation between the items. From the factorial analysis, four factors were generated: (1) benefits of the presence of the family; (2) impairment for professional practice; (3) strategies for the inclusion of the family; and (4) limitation of learning and decision making by the professional. Conclusion: the instruments analyzed obtained a good internal consistency and are indicators of the professionals’ beliefs with the potential to evaluate the quality of family care in this context.

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IMPACT OF CERTAIN EDUCATIONAL INTERVENTIONS ON ADVERSE DRUG REACTION REPORTING BY NURSING HEALTH PROFESSIONALS AT A TERTIARY CARE HOSPITAL

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i6.37266 ◽

2020 ◽

pp. 175-180

Author(s):

SUPRIYA SONOWAL ◽

CHETNA K DESAI ◽

JIGAR R PANCHAL

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Health Professionals ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Educational Interventions ◽

Care Hospital ◽

Post Intervention ◽

Adr Reporting ◽

Nursing Health

Objectives: The objectives of the study were to evaluate the impact of certain educational interventions on adverse drug reaction (ADR) reporting by nursing health professionals at a tertiary care hospital. Methods: Knowledge, attitude, and practice (KAP) of the nurses regarding ADR reporting were evaluated before and after interventions using a KAP questionnaire. Educational interventions carried out among the nurses were workshops, booklets, SMSes, personal briefings, and posters. Number and quality of ADR reported by nurses in pre-intervention (3 months), intervention (10 months), and post-intervention (3 months) phase were compared. Results: There was a significant increase in response rate to questionnaires in the post-intervention phase (post-IP) (97.74%) as compared to pre-intervention (91.28%) phase (pre-IP). The knowledge score of the nurses increased significantly in post-IP (11.65 ± 2.14) as compared to the pre-intervention (6.98 ± 2.46) phase. No ADR was reported by nurses in pre-IP. Thirty nurses reported 30 ADRs in the intervention phase and six nurses reported six ADRs in the post-IP. The mean score of completeness of ADR notification forms decreased significantly in post-IP. Maximum ADRs (10) were reported after the workshops. Conclusion: Educational interventions improved the KAP of ADR reporting by nurses, albeit temporary. This suggests the need of continuous educational interventions.

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

10.21203/rs.3.rs-22231/v3 ◽

2020 ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Tertiary Care ◽

Median Number ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Number Of Visits

Abstract BackgroundAsylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.MethodsWe performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. ConclusionsHospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

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Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

10.21203/rs.3.rs-84330/v3 ◽

2021 ◽

Author(s):

Maria Khan ◽

Uzair Yaqoob ◽

Zair Hassan ◽

Muhammad Muizz Uddin

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Road Traffic ◽

Tertiary Care ◽

Initial Assessment ◽

Care Hospital ◽

Mild Tbi ◽

Epidemiological Characteristics ◽

The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

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