Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs). This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27%) were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation) hospitalization duration was 3.04 (±0.71) days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602). The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205). Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699). Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization costs, and the lack of cardiovascular complications in patients observed at 1-month follow-up after discharge, it is recommended that appropriate evaluations be performed in emergency units to prevent unnecessary admissions. Keywords: bed occupancy, hospitalization expenses, low-risk patients, chest pain, exploitation of resource

بررسی میزان دانش و عملکرد پرستاران اورژانس بیمارستان امام خمینی جیرفت از نحوه تریاژ داخل بیمارستانی

Introduction: Hospital triage is part of the structure of the emergency department, which is performed by nurses. Little information is available about the level of nurses' knowledge of triage. The present study was performed with the aim of evaluating the knowledge of nurses in the emergency department of Imam Khomeini Hospital, Jiroft, Iran, on hospital triage. Methods: This study was a cross-sectional (descriptive-analytical) study. Census method was used for sampling and 60 of the emergency personnel of Imam Khomeini Hospital, Jiroft, Iran in 2019 were selected entered the study. Data were gathered using a valid and reliable questionnaire. After codifying and entering the data, they were analyzed using STATA statistical software and descriptive and analytical statistical tests. Results: 60 of the emergency personnel of Imam Khomeini Hospital in Jiroft entered the study. The mean age of the staff was 30.43 ± 8.23 years, the minimum age of the participants was 23 years and the maximum was 51 years. The mean score of nurses' knowledge was 11.2 ± 3.84. Among the studied staff, 39 (65%) had poor scores, while only 21 (35%) had moderate scores. There was no significant correlation between demographic variables and knowledge score. Conclusion: Nurses' poor knowledge on hospital triage can be due to the lack of formal specialized triage training courses and the lack of obligation for emergency departments to make evidence-based decisions. Considering that guidelines in this regard are very important and necessary and not adhering to them might put the life of the patients at risk, workshops need to be held for the personnel in this regard to improve the level of knowledge of nurses.مقدمه : تریاژ بیمارستانی جزیی از ساختار بخش اورژانس است که توسط پرستاران صورت می­گیرد، اطلاعات کمی از میزان آگاهی پرستاران از تریاژ در دست است، مطالعه حاضر با هدف ارزيابي اگاهي پرستاران اورژانس بیمارستان امام خمینی(ره) جیرفت در زمينه ترياژ بيمارستاني انجام شد. روش کار: اين پژوهش به صورت مقطعی (توصیفی-تحلیلی) بود. جهت جمع­آوری داده­ها از روش سرشماری استفاده شد و 60 نفر از پرسنل اورژانس بیمارستان امام خمینی شهرستان جیرفت در سال 1398 انتخاب و وارد مطالعه شدند. در این پژوهش جهت جمع­آوري اطلاعات از پرسشنامه استانداردی که روایی و پایایی آن سنجیده شده است، استفاده گردید. داده­ها جمع­آوری شد و پس از کدبندی و ورود داده­ها با نرم افزار آماری stata و با استفاده آزمون­های آماری توصیفی و تحلیلی تجزیه و تحلیل شد. یافته ها: 60 نفر از پرسنل اورژانس بیمارستان امام خمینی شهرستان جیرفت وارد مطالعه شدند. میانگین سنی پرسنل 23/8 ± 43/30 سال، حداقل سن شرکت کنندگان 23 سال و حداکثر 51 سال بود. میانگین نمره­ی آگاهی و عملکرد پرستاران 84/3 ± 2/11 بود. 39 نفر (65%) از پرسنل در سطح ضعیفی بودند در حالی که تنها 21 نفر (35%) در سطح متوسطی بودند. بین متغیرهای دموگرافیک و نمره آگاهی و عملکرد تریاژ ارتباط معنی داری وجود نداشت. نتیجه گیری: آگاهی کم پرستاران در مورد تریاژ بیمارستانی می­تواند ناشی از نبود دوره­هاي آموزش رسمی تخصصی تریاژ و عدم الزام بخش­هاي اورژانس به تصمیم­گیري مبتنی بر شواهد باشد. با توجه به این که تدابیر لازم در این خصوص بسیار لازم و ضروری می باشد و در صورت عدم رعایت آنها گاها ممکن است جان بیمار به خطر بیافتد،‌ نیازمند برگزاری کارگاه­هایی در این خصوص برای این افراد می­باشیم تا سطح آگاهی و عملکرد پرستاران را بالاتر ببریم