A rare cause of negative explora tory laparotomy in severe blunt trauma

peer reviewedWe report the case of a young man involved in a high velocity road traffic accident. He presented with multiple injuries and a shock. This shock was suspected to be caused by an intra-abdominal bleeding and an exploratory laparotomy was performed. The procedure did not identify any intra-abdominal bleeding and the source of bleeding was found lately: an intramuscular active bleeding in the dorsal and lumbar muscular compartments. This case was discussed in our local mortality and morbidity meeting

A success story of clinical debriefings: lessons learned to promote impact and sustainability.

peer reviewedThe COVID-19 crisis impacted emergency departments (ED) unexpectedly and exposed teams to major issues within a constantly changing environment. We implemented post-shift clinical debriefings (CDs) from the beginning of the crisis to cope with adaptability needs. As the crisis diminished, clinicians voiced a desire to maintain the post-shift CD program, but it had to be reshaped to succeed over the long term. A strategic committee, which included physician and nurse leadership and engaged front-line staff, designed and oversaw the implementation of CD. The CD structure was brief and followed a debriefing with a good judgment format. The aim of our program was to discover and integrate an organizational learning strategy to promote patient safety, clinicians' wellbeing, and engagement with the post-shift CD as the centerpiece. In this article, we describe how post-shift CD process was performed, lessons learned from its integration into our ED strategy to ensure value and sustainability and suggestions for adapting this process at other institutions. This novel application of debriefing was well received by staff and resulted in discovering multiple areas for improvement ranging from staff interpersonal interactions and team building to hospital wider quality improvement initiatives such as patient throughput

Acute pulmonary embolism: about paradox, judgments and evidences

peer reviewedPulmonary embolism (PE) is the third most common cardiovascular disease in industrialized countries. Multiple clinical presentations and non-specific symptoms lead to frequents misdiagnosis. Using and plan therapeutic and admission versus discharge strategies

A rare cause of negative exploratory laparotomy in severe blunt trauma

peer reviewedWe report the case of a young man involved in a high velocity road traffic accident. He presented with multiple injuries and a shock. This shock was suspected to be caused by an intra-abdominal bleeding and an exploratory laparotomy was performed. The procedure did not identify any intra-abdominal bleeding and the source of bleeding was found lately: an intramuscular active bleeding in the dorsal and lumbar muscular compartments. This case was discussed in our local mortality and morbidity meetin

Impact of the Covid-19 crisis on the hospital work environment and organization: A mixed-methods study

peer reviewe

Management of emergency department inflows during the COVID-19 outbreak in the CHU of Liege : efficiency of an advanced triage center

peer reviewedrésumé : La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institu- tions hospitalières à une série de réorganisations singulières soutenues par l’activation du Plan d’Urgence Hospitalier. Cet article a pour objet de décrire l’expérience du Centre Hospitalier Universitaire de Liège (CHU de Liège) durant la pandémie de COVID-19 et de relater l’efficience de la mise en place d’un centre de tri avancé en amont des services d’urgences pour la gestion des admissions hospitalières. Méthodes : dès le 2 Mars 2020, le CHU de Liège a mis en place une infrastructure d’accueil des patients suspects d’infection par le SARS-CoV-2. D’abord initiée au sein de l’institution hospitalière, la nécessité d’une infrastructure indépendante s’est rapidement révélée indispensable et a, dès lors, vu le jour dès la fin du mois de mars, sur les deux sites hospitaliers universitaires. Du 2 mars au 3 mai 2020, l’ensemble des données relatives aux visites au sein des centres de tri avancé ont été collectées (nombre d’ad- missions, motif des visites, examens complémentaires et évolutions cliniques). Résultats : sur la période de l’étude, 3.094 patients ont transité par les centres de tri du CHU de Liège. Cette fréquentation était constituée d’un volume global de 3.431 contacts dont 337 représentaient des réad- missions. La sensibilité et la spécificité des centres de tri en regard de la nécessité d’une hospitalisation étaient, respectivement, de 87,9 % et 93,4 %. Conclusion : notre expérience suggère une efficience optimale des centres de tri avancé, en amont des structures hospitalières tradi- tionnelles, pour orienter de manière appropriée le flux des patients suspects d’infection par le SARS-CoV-2

Immersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience

Objectives: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective solution proposed in disaster medicine, also works well to manage Emergency Department (ED) flow. The aim of this study was to describe the role of an ED Triage Center for patients with suspected novel coronavirus disease (Covid-19) and character- ize the patient flow. Methods: In March 2020, we established a Covid-19 triage center close to the Liège University EDs. From March 2 to March 23, we planned to analyze the specific flow of patients admitted to this triage zone and their characteristics in terms of inner specificities, work-up and manage- ment. During this period, all patients presented to the ED with symptoms suggestive of Covid- 19 were included in the study. Results: A total amount of 1071 patients presented to the triage center during the study period. 41.50% of the patients presented with flu-like symptoms. In 82.00% of the cases, no risk factor of virus transmission was found. The SARS-Cov2 positive patients represented 29.26% of the screened patients. 83.00% of patients were discharged home while 17.00% were admitted to the hospital. Conclusion: Our experience suggests that triage centers for the assessment and management of Covid-19 suspected patients is an essential key strategy to prevent the spread of the disease among non-symptomatic patients who present to the EDs for care. This allows for a disease- centered work-up and safer diversion of Covid-19 patients to specific hospital units