Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke

Introduction: Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective: The aim of this study was to assess the possible impact of emergency department (ED) crowding on the quality of care for acute stroke patients. Methods: In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM) residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results: The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05). Conclusion: In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients

‎ The Association between Life Satisfaction and the Extent of ‎Depression, ‎Anxiety and Stress among Iranian Nurses: A ‎Multicenter Survey

Objective: The determinants of satisfaction of life (SWL) are poorly described among Iranian employed ‎nurses. This study aimed to assess the effect of various factors including age, gender, marital ‎status, depression, anxiety and stress on SWL among Iranian nurses.‎ Method: Employed nurses in three teaching hospitals were invited to participate in this study. Ninety-four ‎nurses (65 women and 29 men) participated in this study. Depression, anxiety, stress scale ‎‎ (DASS-21) was used to measure the related variables. Satisfaction with Life Scale (SWLS) was ‎used to assess SWL. Multivariate analysis was utilized to examine the relationship between ‎multiple variables. Results: A noticeable proportion of Iranian employed nurses were either dissatisfied or extremely ‎dissatisfied with life (45%). Severe depression was related to lower scores of SWLS (P: 0.001, r ‎‎= -0.32). The similar outcomes were detected between anxiety and stress scales, and SWLS (P: ‎‎0.023, r = -0.23 and P: 0.008, r = -0.27 for anxiety and stress, respectively). Although females ‎were more vulnerable to depression (P: 0.010) and stress (P: 0.013), the overall effect of gender ‎on SWL was insignificant (0.41). Satisfactions with financial power and work environment were ‎associated with higher scores of SWLS (P: 0.030 and 0.042, respectively). Marital status was not ‎related to severity of depression, anxiety, stress and SWLS (P: 0.39, 0.38, 0.80, and 0.61, ‎respectively). ‎ Conclusion: This study revealed that poor satisfaction with financial status and work environment, ‎depression, anxiety and stress are the major determinants of satisfaction with life among Iranian ‎employed nurses.