A Novel Triage for Crowded Emergency Clinics: Patient Triage

More effective and accurate methods of triage are needed for overcrowded emergency clinics. In this study, the starting point was taken as the patient is the primary and most important factor in determining emergency condition, and thus, the triage was conducted by the patient him/herself. The study involved 308 patients over the age of 16 who were admitted to the Adult Emergency Clinic of Emergency Medicine Department, Hacettepe University Medical School, between May 1st and 9th, 2010. The mean age of the patients was 46 years (SD ± 20.894). Of the patients, 47.9% (n=147) were male, 52.1% (n=160) were female. Considering the complaints of the patients at presentation, and compatibility of diagnosis at triage, Kappa statistics were used and the compatibility rates were as follows: 49.8% in the patients, 41.8% in the paramedics, 63.8% in the nurses, 6.2 % in the intern doctors, 62.6% in the junior residents, 65% in the senior residents, and 66.5% in the specialists. The accuracy rates of prediagnosis based on the patient complaints were 53.1% (n=163) for the patients, 67.1% (n=206) for the paramedics, 71.2% for the nurses, 64.5% (n=198) for the intern doctors, 73% (n=224) for the junior residents, 80.8% (n=248) for the senior residents, and 82.4% (n=253) for the specialists. The overtriage and undertriage rates of the patients were 25.1% and 15.5% respectively, which are compatible with the recommendations by American College of Surgeons Committee on Trauma (ACSCOT). The patients were found successful in establishing the correct triage and diagnosis for themselves. Thus, in cases where the patient him/herself cannot cooperate, experimentation with triage scales developed to involve active participation of patients relatives may be helpful. In addition, active participation will significantly reduce the rates of complaints for waiting times and related arguments among patients. [Med-Science 2014; 3(3.000): 1396-407

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital

Aşırı Kalabalık Aciller İçin Şikayet Temelli Bir Model: Beş-Düzeyli Hacettepe Acil Triyaj Sistemi

BACKGROUND To compare ESI Five-Level Triage System with 5-Level Hacettepe Emergency Triage System (HETS), which was developed for Overcrowded EDs in our country. METHODS Over a period of six days, patients were assessed by a different ED staff everyday using HETS, then re-evaluated blindly by an emergency. physician using HETS. Then patients were evaluated blindly for a third time by an independent, ESI-using emergency physician. RESULTS Of the patients in the study, 133 were men, 175 were women and the average age was 44.41 +/- 18.033. Inter-rater agreement was 97.40% (Kappa=0.963) between HETS and HETS-Blind, 74.35% (Kappa=0.646) between HETS and ESI-Blind, 74.67% (Kappa=0.652) between HETS-Blind and ESI-Blind. Inter-observer agreement between the second emergency physician performing HETS-Blind and the first emergency physician, resident, or nurse was very good (Kappa=1.0). Intern doctor, non-medical secretary and paramedic were found to have almost very good agreement (Kappa=0.971; 0.935; 0.864, respectively). An overtriage of 7.25% and undertriage of 1.08% were found in HETS. CONCLUSION Complaint-based HEST developed for overcrowded EDs is a triage system with a very good agreement between observations and observers, low undertriage and overtriage ratios, and easy application by all staff from a non-medical secretary to the emergency physician.WoSScopu

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity