Success of applying early goal-directed therapy for septic shock patients in the emergency department

BACKGROUND: Since early goal-directed therapy (EGDT) became standard care in severe sepsis and septic shock patients in intensive care units many years ago, we suppose that the survival rate of severe sepsis and septic shock patients improves if the resuscitative procedure is quickly implemented and is initiated in the emergency room. OBJECTIVE: We aimed at recording emergency department time to improve our patient care system as well as determine the rate at which EGDT goals can be achieved. The second analysis is to find out how much we can improve the survival rate. METHODS: This was a prospective observational study in an emergency room setting at a tertiary care facility where EGDT was applied for resuscitation of severe sepsis and septic shock patients. The data recorded were the initial vital signs, APACHE II (Acute Physiology and Chronic Health Evaluation II) score, SAP II (Simplified Acute Physiology II) score, SOFA (Sequential Organ Failure Assessment) score, time at which EGDT goals were achieved (central venous oxygen saturation [ScvO(2)] >70%), initial and final diagnosis, and outcome of treatment. The t-test and Mann–Whitney U-test were used to compare between the achieved goal and nonachieved goal groups. RESULTS: There were 63 cases of severe sepsis in the study period. Only 55 patients submitted a signed consent form and had central line insertion. Twenty-eight (50.9%) cases were male. Thirty-nine (70.9%) patients achieved the goal, and the mean SAP II score was 8. There were no statistically significant differences between the two groups (P-value =0.097). Thirty of the 39 patients (70.9%) survived in the achieved goal group, which was a statistically significant improvement of the survival rate when compared with only one of 16 patients (6.3%) surviving in the nonachieved goal group (P<0.001)

Emergency Department Length of Stay and in-Hospital Mortality of Non-Traumatic Patients in a University Hospital

Objective: To assess the emergency department length of stay (EDLOS) and mortality in each Emergency Severity Index (ESI) triage level. In addition to identifying the cut-off point of EDLOS to predict 72-hour in-hospital mortality among adult non-traumatic patients in the ED of a university hospital. Material and Methods: A cross-sectional study was conducted by retrieving patient data from the hospital information system; from January 1, 2014, to December 31, 2018. Patient characteristics, EDLOS, and in-hospital mortality rates were analyzed using the R program. The cut-off values of EDLOS, via the area under the curve for the best prediction of 72-hour in-hospital mortality in patients at different ESI levels, were analyzed by multivariate analysis. Statistical significance was defined as a p-value of ≤0.05. Results: Data from 71,247 patients with 123,356 visits were enrolled. EDLOS significantly decreased across ESI levels and the in-hospital mortality rates were highest in ESI 1, followed by ESI 2 and ESI 3. The predictive ability of EDLOS was the highest for ESI 4, followed by ESI 3. The cut-off point of EDLOS at 3.58 hours showed the best sensitivity, which was a significant risk factor for mortality after adjusting for other significant variables. An EDLOS longer than 4 hours was a significant factor for poor survival in patients with ESI 2 and ESI 3. Conclusion: A practical cut-off point of 4 hours EDLOS can be used to predict 72-hour in-hospital mortality. Healthcare providers in the ED should consider EDLOS as a safety indicator for quality assurance

The Roles of ARCH Project in the Strengthening of the ASEAN Disaster Health Management

Introduction:The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the project under the collaborative framework between the National Institute for Emergency Medicine, Thailand, Ministry of Public Health, and Japan International Cooperation Agency. The project aims to strengthen disaster health management focusing on the International Emergency Team (I-EMT) operation and coordination in ASEAN by using various mechanisms, for example, regional collaboration meeting, regional collaboration drill, training, etc.Aim:The study aims to evaluate the outcomes which ARCH Project’s activities have been facilitating to strengthen the ASEAN disaster health management.Methods:A comparative study is utilized to see the improvement of the ASEAN disaster health management of the current situation and the project’s outputs compared to the previous survey in 2015.Results:Recent ASEAN disaster health management has been strengthened in three distinctive dimensions: (1.) national capacity of each ASEAN Member States is being strengthened through the project’s training courses; (2.) the ASEAN I-EMT coordination platforms have been set up to the extent that the progress of developing the toolkits such as the Standard Operating Procedures for the Coordination of EMT in ASEAN is at its eighty percent, while the Database of the EMT and their Minimum Requirements and Qualifications are now at its ninety percent; and (3.) Standard reporting forms (medical record and health need assessment form) for all ASEAN member state (AMS) has been developed and fully completed.Discussion:The ARCH Project has been facilitating the strengthening of the ASEAN disaster health management through its capacity building endeavors and the creation of collaborative mechanisms for operations and coordination. These activities should be maintained either under the existing or newly created mechanisms in order to build a sustainable collaborative framework.</jats:sec

Development and Validation of a Scoring Assessment Tool for Hospital Safety: A Pilot Study Comparing Hospital Preparedness in Thailand

Introduction: Safe hospitals are crucial in the management of major incidents and disasters. A hospital self-assessment tool was developed for Thailand to identify gaps and shortcomings in hospital preparedness. However, this tool lacks the ability to determine the level of preparedness and cannot be used to standardize hospital readiness and enable continuous quality control. Objective: The aim of this study was to test a developed scoring hospital assessment tool to evaluate the level of hospital preparedness and enable quality control and compare the results of various hospitals. Material and Methods: Using the nominal group technique, three experts evaluated all sections of the previously developed hospital self-assessment tool and recognized that each element could be answered by one of the three options: Yes, Not Known, and No. A pilot study was conducted in 11 hospitals to evaluate the feasibility of the tool. The number of Yes responses was divided by the total number of elements to represent the level of hospital preparedness and reported as either low (0‒59), average (60‒79), or good (80‒100). The results identified areas for improvement. Results: Eleven out of 13 hospitals (85% response rate) in two provinces were enrolled in the study. The results showed various levels of preparedness in all the investigated hospitals. Two hospitals had low preparedness and needed great improvements. The remaining nine hospitals in the two provinces had average preparedness levels and needed improvements. One of the nine hospitals had a score very close to achieving good preparedness. No significant parameters were associated with the preparedness level. Conclusion: The developed scoring assessment tool for hospital safety demonstrated high utilization feasibility and indicated preparedness levels. The scoring tool also provided assessment levels that could enable continuous quality evaluation and improvements