Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year

Abstract Objective: This study aimed to assess patients who were transferred from emergency services throughout the province of Mardin to out-of-province hospitals by ambulance in a year. Material and Methods: In this study, all patients transferred from emergency services in the province of Mardin to out-of-province hospitals via ambulances by the Patient Referral Assessment Committee, founded under the Provincial Directorate of Health, between the dates of December 31, 2010 and December 31, 2011 were evaluated retrospectively. No exclusion criteria were used. Patients were grouped and analyzed according to their demographic characteristics, transport properties, and reasons for referral. Results: The total number of the patients included in the study was 1518 (55.8% males, 41±27 mean age). Of all, 621 patients (40.9%) were transferred from the center of Mardin province, and the other patients were transferred from 8 district hospitals and two private hospitals. It was found that the patients were transferred to 37 hospitals in 8 provinces, and a total of 562 patients (37%) were transferred to private hospitals. Cardiology (23.3%), pediatrics (11.5%), and obstetrics and gynecology (8.8%) departments were the first three clinics that patients were transferred to frequently, respectively. In total, 274 patients (18.1%) were transferred inappropriately. There was a statistically significant difference between patients' transfer hospitals (state hospital/private hospital) and the age of the patients (younger than 18 years/18 years or older) (p<0.001). In addition, the rate of adult patients' transfers to tertiary healthcare centers was significantly higher (p<0.001). Conclusion: In Mardin, cardiology, pediatrics and obstetrics and gynecology patients are the most common group of emergency patients transferred by 112 ambulances to out-of-province hospitals. Approximately 40% of the patients were transferred to private hospitals. Inappropriate patient transfers seem to be a major problem in this study, as in other studies conducted in Turkey. (JAEM 2014; 13: 62-6

Evaluation of impact of fast track on emergency overcrowding

ASK gün geçtikçe artan oranda AS‟lerin iŞleyiŞini olumsuz olarak etkilemektedir. ASK sorununun çözülmesine yönelik çeşitli çözüm önerileri mevcuttur. Bu önerilerden birisi de Fast Track (FT) -Hızlı Bakı Birimi uygulamasıdır. Bu çalışmada HBB uygulamasının ASK‟na olası etkisi araştırılmıştır. Asıl amaç bu olmakla birlikte, bu uygulamanın, hasta bekleme sürelerine, hastaların AS‟de toplam kalış sürelerine, muayeneden olmadan ayrılan hasta sayısına, hasta memnuniyetine, bedel-etkinliğe, hastaların konsülte edilip edilmeme oranlarına, morbidite ve mortaliyeteye etkileri de incelenmiştir. HBB uygulamasının ideal zaman aralığı da tespit edilmeye çalışılmış. Ayrıca AS çalışanlarının bu uygulamaya yönelik düşünceleri de anket yöntemiyle öğrenilmeye çalışılmıştır. Gereç ve Yöntem: Çalışma Ankara‟da Gazi Üniversitesi Hastanesi Erişkin AS‟de 17.09.2010-30.09.2010 tarihleri arasında yapılmıştır. Bir hafta süresince 24 saat HBB uygulaması yapılmış, diğer hafta ise HBB uygulaması yapılmamıştır. Bu iki haftadaki hastalar karşılaştırılarak HBB uygulamasının ASK‟na etkileri araştırılmıştır. HBB uygulamasına uygun hasta seçerken Kanada Triaj Skorlaması kullanılmış olup triaj skoru 4-5 olan hastalar çalışmaya dahil edilmiştir. Triaj skoru 1-3 olan diğer hastaların da yaş, cinsiyet, triajda bekleme süreleri de ayrıca değerlendirilmiştir. Tedavi süreci bitiminde, Kanada triaj skoru 4-5 olan hastalardan memnuniyet anketi doldurmaları istendi. Kabul eden hastalara memnuniyet anketi uygulanmış, soruların cevaplarında 5‟li Likert yöntemi kullanılmıştır. Her iki hafta boyunca NEDOCS ölçümü yapılmış ayrıca AS çalışanlarının da NEDOCS tahmini yapmaları istenmiştir. AS‟de muayene olamadan ayrılan ambulans ve ayaktan hasta başvuran hasta sayıları da kaydedilmiştir. Bulgular: HBB uygulanan haftada diğer haftaya göre NEDOCS skoruna göre ASK istatistiksel olarak anlamlı şekilde daha az bulunmuştur. Hasta bekleme süreleri ve hastaların AS‟de toplam kalış süreleri ve muayene olmadan ayrılan hasta sayıları da yine HBB uygulanan haftada istatistiksel olarak anlamlı olarak daha az tespit edilmiştir. Çalışmada HBB uygulanan haftadaki HBB hastalarının memnuniyetleri de HBB uygulaması olmayan haftadaki hastalara göre istatistiksel olarak anlamlı olarak daha yüksek bulunmuştur. Hastaların ortalama maliyetlerine, konsülte edilme oranlarına, morbidite ve mortaliteye bakıldığında HBB uygulanan hafta ile uygulanmayan hafta arasında anlamlı fark saptanmamıştır. HBB‟nde değerlendirilen hastaların saat dilimlerine göre başvuru sıklığına bakıldığında saat 12:00-16:00 ve saat 20:00-24:00 arasında istatistiksel anlamlı şekilde daha çok hasta başvurusu olduğu tespit edilmiştir. Sonuç: HBB uygulaması ASK‟nı, hasta bekleme sürelerini, hastaların toplam AS‟de kalış sürelerini, muayene olmadan ayrılan hasta sayısını azaltmış, hasta memnuniyetlerini arttırmıştır.Background: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and emergency crowding. The study objective was to determine the impact of a fast track area on emergency crowding and both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. Left without being seen (LWBS) rates and mortality rates) in non-urgent patients. Non-urgent patients were defined as whose Canadian Triage Acuity Scale (CTAS) was 4 and 5. The National Emergency Department Overcrowding Study (NEDOCS) was used to measure the ED overcrowding. Methods: The study took place in Ankara, at Gazi Univercity, Faculty of Medicine, Emergency Medicine Department. This study examined the impact of FT on a preintervention study group versus post-intervention control group. Results: NEDOCS skore of FT week was less than non-FT week. Patiens‟ saticfaction was higher in FT group. LWBS was decreased 53% and WT was decreased 54,9% in FT week. Morbidity and mortality rates remained unchanged. Conclusion: The FT decreased NEDOCS skore. It also improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates, patient satisfaction)

Intravenous Lipid Emulsion Therapy for Acute Synthetic Cannabinoid Intoxication: Clinical Experience in Four Cases

There is no specific antidote for intoxication with synthetic cannabinoids. In this case series, we considered the efficiency of intravenous lipid emulsion therapy in four cases, who presented to emergency department with synthetic cannabinoid (bonzai) intoxication. The first patient had a GCS of 3 and a left bundle branch block on electrocardiography. The electrocardiography revealed sinus rhythm with normal QRS width after the treatment. The second patient had bradycardia, hypotension, and a GCS of 14. After intravenous lipid emulsion therapy, the bradycardia resolved, and the patient’s GCS improved to 15. The third patient presented with a GCS of 8, and had hypotension and bradycardia. After the treatment, not only did the bradycardia resolve, but also the GCS improved to 15. The fourth patient, whose electrocardiography revealed accelerated junctional rhythm, had a GCS of 13. The patient’s rhythm was sinus after the treatment. Cardiovascular recovery was seen in all four cases, and neurological recovery was also seen in three of them. Based on the fact that intravenous lipid emulsion is beneficial in patients intoxicated with lipophilic drugs, unstable patients presenting to the emergency department with acute synthetic cannabinoid intoxication may be candidates for intravenous lipid emulsion treatment

Occipital epidermoid cyst of furuncular myiasis presenting with spontaneous bleeding: a case report.

A 77-year-old female patient was presented to the emergency department with swelling and bleeding in the occiput. It was learned from the patient that the soft tissue swelling on her head had been present for 1 year, and she had no history of trauma. The patient had diabetes mellitus and hypertension and a history of breast cancer 15 years ago. An epidermoid cyst, approximately 5x5 centimeter in size, bleeding in the form of leakage was observed on the patient's occipital scalp. There was no intracranial pathology in the brain computerized tomography. Wound debridement revealed that the cyst contained approximately 30 live larvae. All larvae were cleaned from the tissue defect. When looking from the outside, the larvae were 8-12 millimeters in size, yellow-white, spiral in shape, and were thought to be compatible with the larva of Lucilia sericata diptera. Myiasis is an ectoparasitic infection of diptera larvae by settling in human and animal tissues. When flies leave their larvae in the tissue, the larvae that invade and develop in that area cause infection. Cutaneous myiasis is the most common clinical form and can be seen on the scalp and cause furuncular myiasis. Immunosuppression, lack of self-care, travel to endemic areas and trauma have been reported as risk factors for myiasis. It was thought that the history of diabetes and old malignancy might be predisposing in our patient. In this case report, it is aimed to present a case of furuncular myiasis that settled down without any trauma to the occiput and presented with spontaneous soft tissue bleeding

Predictive ability of the MEWS, REMS, and RAPS in geriatric patients with SARS-CoV-2 infection in the emergency department

To compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30 day-mortality in patients with SARS-CoV-2 infection aged 65 years and over. Methods: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 years and over with patients confirmed to have SARS-CoV-2 infection according to the RT-PCR test, who presented to the emergency department between March 1, 2020 and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS and RAPS values of the patients were recorded prospectively. Results: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) years. The rate of 30-day mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS and REMS were 0.512 [95% confidence interval (CI): 0.420-0.604, p = 0.910], 0.500 (95% CI: 0.408-0.592, p = 0.996), and 0.675 (95% CI: 0.585-0.757, p = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2) and REMS (>5) for 30-day mortality were 0.374 (95% CI: 0.089-1.568, p = 0.179), 1.696 (95% CI: 0.090-31.815, p = 0.724), and 1.008 (95% CI: 0.257-3.948, p = 0.991), respectively. Conclusion: REMS, RAPS and MEWS do not seem to be useful in predicting 30-day mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency departmen