Causes of Prolonged Emergency Department Stay; a Cross-sectional Action Research

Introduction: Based on the existing standards, patients presenting to emergency department (ED) should receive a decision in a maximum of 6 hours after admission to ED and leave ED in this time. Unfortunately, most of the time, especially in general and referral hospitals, we witness patients staying in the ED for hours or even days after a decision has been made. Objective: the present study was performed with the aim of evaluating the causes of patients’ prolonged length of stay in ED of one of the major hospitals in Tehran, Iran. Method: The present cross-sectional action research was carried out in the ED of Imam Khomeini Hospital, Tehran, Iran, in November and December 2016. The studied population consisted of patients who stayed in ED for more than 12 hours. In a panel consist of specialists, semi-structured and open questions were asked from the participants. All the interviews were recorded and converted to text. Effective factors of staying more than 12 hours in ED mentioned by the interviewees were extracted. A checklist of evaluating the causes of more than 12 hours stay in ED was prepared. In the next stage, by daily visit to the ED of the studied hospital, profile of the patients who had stayed in the ED for more than 12 hours was evaluated and the variables determined in the checklist were assessed. Results: In the present study, 407 patients with the mean age of 54.07±20.18 years (minimum 1 and maximum 113 years) were studied, 270 (65.7%) of which were male. Respectively, 26 (6.4%) were admitted in triage level 1, 203 (49.9%) in triage level 2, 168 (41.3%) in triage level 3, 9 (2.2%) in triage level 4 and 1 (0.2%) in triage level 5. Based on these findings, “services not wanting to transfer patients with decisions to the service” was the most common factor. Conclusion: In the present study, specialized services not tending to dislocate the patients that have been decided upon to their respective department, a considerable number of complicated patients and patients with advanced underlying illnesses among those presenting to ED, and shortage of beds in specialized departments and ICU, were the most common causes affecting more than 12 hours stay of patients in the studied ED

Evaluation of Some Aspects of Educational Inputs and Outputs of Community Medicine Departments in Iran Medical Sciences Schools and Universities

Background: Human health is strongly related to economic, political, cultural, administrative and environmental conditions. Therefore, Medical sciences are not limited to biomedical sciences but also include social and psychological sciences. This viewpoint has led to an outlook named Community-Oriented Medicine. After integration of Health System with Medical Education in Iran, conditions for Community- oriented Medical Education were provided and the departments of "Community Medicine" in universities with Faculty of Health and departments of "Health and Community Medicine" in universities without "Faculty of Health" were established. In spite of various attempts, there is still no evidence showing the outputs and outcomes of Community-oriented activities in Community Medicine Departments of our universities. Objective: This study was performed to determine the statue of Community Medicine Departments of all Medical Sciences schools and Universities of Iran in regard to their facilities and resources. Methods: In this descriptive cross- sectional study some inputs and outputs of educational and research processes of departments of Community Medicine in all Medical Sciences Universities affiliated to the Ministry of Health, Treatment and Medical Education were analyzed. Results: Educational facilities and learning aids of first class universities were to some extent adequate but inadequate in the two other classes. Community Medicine Departments in all three classes of universities were active in conducting students’ theses but they were not very active in publishing books and articles and conducting research projects. Conclusion: Transition from traditional Medical Education to the community-oriented Medical Education requires short-term and long-term programs for improving Community Medicine Departments and making them closer to standard goals. Keywords: Educational evaluation, Community Medicine, Educational resource, Community- oriented Medical Education

Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients’ flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients’ charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel’s evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen’s weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen’s weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses

Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients’ flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients’ charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel’s evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen’s weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen’s weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses

Extremity Fracture Diagnosis Using Bedside Ultrasound in Pediatric Trauma Patients Referring to Emergency Department; A Diagnostic Study

Background This study performed to assess the efficacy of ultrasound in screening upper and lower extremities fractures in comparison with standard X-ray in pediatric trauma patients. Materials and Methods This was a prospective diagnostic study conducted at the emergency department of Imam Khomeini Complex Hospital, Tehran, Iran. All patients with the age under 18-year-old admitted with limb trauma were first evaluated by attending emergency medicine physician using ultrasound and then underwent necessary X-rays. Thereafter, the ultrasound reports were compared with X-ray reports regarding measurement of its accuracy. Results Forty patients with the mean age of 9.47 ± 5.26 years (minimum of 2 and a maximum of 17 years) entered the study (75% were male). The average time of performing ultrasound in pediatric population is 3.99± 0.83 minutes which is statistically significant compared to X-ray, 16.12 ± 4.15 minutes (

The First Study of Patient Safety Culture in Iranian Primary Health Centers

Although the error in health care has received attention recently, patient safety culture in health centers has been relatively neglected. To measure the patient safety culture in primary health centers. A cross-sectional study, utilizing the modified version of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) and a demographic questionnaire. Healthcare staffs from health centers were participated in the survey. The patient safety culture score including subscores on 11 dimensions and 39 items; patient safety grade and number of events reported. The overall positive response rate of patient safety culture was 57 ±16.8 (CI 9555%-59%). The dimensions that received higher positive response rate were "Teamwork across units of health center", "Teamwork within units", "Head of center support for patient safety". The lowest percentage of positive responses was "Non punitive response to error". There were no relationship between working years and patients safely culture score. Similarly, no relationship was found between professional, gender and total patients safely culture score. Statistical analysis showed discrepancies between Iranian health centers and the US hospitals in three dimensions. For improving patient safety culture in health centers, it is necessary to have enough staff and establish an environment to be open and fair with staff which helps report errors spontaneously and without any fear. The findings of this study could be used to measure changes in patient safety culture over the time

Comparison of Serum Uric Acid, Iron and Total Iron Binding Capacity (TIBC) Levels in Pre-eclamptic and Normal Pregnant Women

Objective: The objective of our study was to compare uric acid, iron and TIBC levels in normal and preeclamptic pregnant women and determine their relations with maternal and fetal complications. Materials and methods: A case control study was conducted in 200 normal and preeclamptic pregnant women. At 32-40 weeks of pregnancy (third trimester) a blood test was taken in order to measure the uric acid, iron and TIBC and their relation with maternal and fetal complications. Results: Uric acid level showed significant difference (4.58 ± 0.73, 4.87 ± 0.58, p=0.002) between  two groups of pre-eclamptic and normal women.  The iron and TIBC level had no significant difference in either group. The uric acid level and iron had significant differences between two groups with and without maternal complication, respectively (4.69 ± 0.66, 5.05 ± 0.59, p<0.05) (387.42 ± 82,  405.24 ± 57, p<0.05). There was not any difference in three parameters between groups with and without fetal complication. The BMI was significantly higher in preeclamptic group and has positive relation with uric acid level. If we consider 29 as BMI cut-off point; it will be associated with 73% sensitivity and 67% specificity in preeclampsia determination. Using 4.55 as uric acid cut-off point, the sensitivity is 76% and specificity is 49%. Conclusion: Although the higher level of uric acid, higher BMI scale and positive roll-over test are associated with preeclampsia, but they are not very strong predictors as single test

The corneal volume and biomechanical corneal factors: Is there any correlation?

Abstract BACKGROUND: The aim of this study was to determine the correlation between corneal hysteresis (CH) and the corneal resistance factor (CRF), which are both novel methods of analyzing ocular rigidity/elasticity, and various corneal characteristics, mainly corneal volume in normal subjects

Effect of the training of the child development monitoring on stress and parenting satisfaction of mothers

The impact of stress on physical and mental health is undeniable and today, many mothers have parental stress. This study aimed to examine effect of training of growth monitoring period to reduce parenting stress and improving the level of satisfaction of mothers' parenting. Study's population included mothers of children 1 to 4 years old that in the form of available sample were selected to participate in training. 93 mothers were included in the intervention group for training and 57 mothers were included in the control group in form of quasi-experimental design. Parenting stress scale and parental satisfaction scale were used to collect data. Results showed the training of monitoring period decreased parenting stress levels and increased parenting satisfaction (t=15.29, p=0.001). This training reduces the parent – child dysfunctional interaction, parental distress, and problematic child characteristic. It seems to help mothers during child-rearing and provide the necessary information to them about the child and their natural features and modification of mothers' false beliefs and knowledge in this field can be used for the protective role of mothers and their children in the face of stress, and facilitate the process of parenting