Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 13

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
logic disorders (11/68;16%), intoxications (4/68;6%), miscellaneous
medical conditions including sepsis (8/68;12%), and psychiatric
causes (2/68;3%). 3 patients died without established cause of
coma. In the earlier studies, ethanol intoxication, trauma, and cere-
brovascular disease were common causes of coma; uncommon
causes included hypoglycemia, tuberculous meningitis, and poiso-
ning with illuminating gas, bromide, and permanganate.
Conclusion: Patients with acute coma comprise a heterogeneous
group from many different causes. The etiology of acute coma in a
modern U.S. emergency department differs substantially from the
only descriptions in the literature published about 70 years ago.
Some frequently encountered current causes of coma were not
described in earlier studies, and some causes of coma previously
described were not encountered in the modern day study.
O 12 - ED Systems: Efficiency, Productivity
Changing concepts towards emergency medicine in ED
Rambam Medical Center, Israel
Basis F, Otets L, Michelson M
Rambam Medical Cenler, Haifa, Israel
Background: The Rambam Medical Center is a referral hospital for
the north of Israel, with 950 beds and 30 ED beds. Our emergency
department was divided before our era into two separate units, a
trauma and a medical one. In the medical unit, specialists in internal
medicine treated patients, from an internal medicine viewpoint.
Evaluation lasted many hours with an abuse of lab and imaging
services. After evaluation, some patients remained in the ER 9
hours to 3 days waiting for admission.
Objectives: To change the pattern of work and concepts towards
emergency medicine, and to improve the treatment of patients in
the ED.
Methods: The department was united into one ED, managed by a
head of the department, a specialist in emergency medicine and
traumatology, and a deputy head who is a specialist in emergency
and internal medicine. We defined the goals of the ED. Its main
goal is triage of patients towards admission or discharge with the
minimal time needed for evaluation. The ED is no more considered
as a semi internal medicine department. Special concern was given
to emergency medicine and ACLS protocols, wise use of lab,
imaging and consultation facilities, and changing the attitude
towards management of acute pain.
Results: There was a dramatic reduction in the number of patients
found in the ED each morning (from 30-50 patients, 20-30 of whom
waiting for admission, to 8-10 patients, with only one or two waiting
for admission). The average time needed for evaluation was reduced
from 5 hours to 3.1 hours. The average time from the decision about
admission until admission was reduced from 5.6 to 1.6 hours. Only
12% of the patients remained in the ED more than 4 hours waiting
for admission, compared to 35% previously, and only 1% for more
than 8 hours compared to 20% previously. Although the number of
patients admitted to the ED was constant, the number of blood and
urine cultures taken in the ED was reduced by 81% and 86.3%
respectively. The number of blood tests sent from the ED was
reduced by 23% and from the medical ER by 36%.
Conclusions: Changing concepts in the ED must start from the
highest levels of the hospital including the hospital director. The
implication of new written protocols for treatment, with the aid and
backing of the hospital management are needed.
O 13 - ED Systems: Efficiency, Productivity
How to improve Emergency Department (ED) effectiveness from
ED occupancy analysis
Sanchez M
Hospital Clinic, Barcelona, Spain
Objective: It seems to be obvious that Emergency Department
(ED) overcrowding is linked to an effectiveness deterioration, but
it is difficult to demonstrate scientifically. The aim was to define
effectiveness, to study reasons for patients' continued stay in ED,
and to establish the level of relationship between both of them.
Methods: For 3 consecutive weeks, we recorded at 3-hour intervals
the number of arrivals, the number of patients waiting to be seen,
the waiting time (the mean of waiting time of the three patients
waiting for longer) and the number of patients placed in the ED as
well as the reason for their continued stay. These reasons were
divided into: A) factors related to the ED itself: Al-waiting for a
physician, A2-being visited, A3-waiting for test results, A4-clinical
evolution; B) factors related to hospital itself: Bl-waiting for a bed
going to be left, but still occupied, B2-waiting to have a bed (lack of
bed at that specific 3-hour interval); C) factors related to ED
interrelations: Cl- waiting for test performed out of the ED, C2-
waiting for hospital consultant; D) factors not directly related to
ED or hospital: Dl- waiting for ambulance, D2-waiting for relative,
D3- waiting for social assistant. ED occupancy rate (OR) was
calculated as a rate between the number of patients placed in it and
the number of boxes. Percentage of OR due to each reason was
calculated as well. Two effectiveness markers were defined: E1
(arrivals/waiting time) and E2 (arrivals/patients waiting).
Results: Many factors had a significant correlation with both
effectiveness markers. However, when a multivariate regression
analysis was performed, a nice correlation was only found between
effectiveness markers and percentage of OR due to the hospital
itself (E l: r=0.38, p<0.001; E2: r=0.34, p<0.001), and specifically OR
due to patients waiting for a bed going to be left (El: r=0.44,
p<0.001; E2: r=0.40, p<0.001).
Conclusions: The more OR increases, the more ED effectiveness
decreases. In this study, OR increase is unfortunately due to inap-
propriate hospital behaviors (such as the fact that inhospital
patients are discharged too late in the evening hours) instead of
other reasons, such as patient arrivals, frequently used to justify ED
overcrowding. These results should be used by hospital administra-
tion as a tool for changing some hospital behaviors that lead to ED
effectiveness deterioration.
0 14- Airway/Respiratory Emergencies
Non invasive mechanical ventilation (NIV) in acute respiratory
failure (ARF) in the emergency department
Ferrari G, De Salvia A, Valentini MC, Petrino R, Aprá F, Masiero P, Oiliveri F
Emergency Medicine Department - St. Giovanni Bosco Hospital -Turin. Italy
Background: Several studies have proven that NIV is successful in
the treatment of ARF.
Objective: evaluate effects of NIV (added to standard medical
Læknablaðið/Fylgirit 45 2002/88 13