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Results for “Emergency Service, Hospital”

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PubMed1997

[Treatment of asthmatic crises at a hospital emergency service. Are the protocols followed?].

Improper assessment and treatment of asthma attacks have been identified as causes of increased morbidity and mortality: several pneumological societies have therefore created and published guidelines for facilitating decision making and for preventing unnecessary failures of therapy. The objective of this study was to examine emergency department compliance with such guidelines in our hospital, comparing the performance of pneumologists and other specialists. We reviewed the records of 117 patients treated for acute asthma attacks in 1994 (87 women and 30 men, mean age 46 years); 37 patients were treated by pneumologists and 80 by other specialists. The two physician groups differed significantly with respect to initial assessment of severity, particularly in the recording of vital signs (p < 0.05) and in the examination of some signs such as the use of accessory musculature (38% versus 10%, for pneumologists and other specialists, respectively) or the presence of cyanosis (81% versus 55%). Other factors associated with risk of death were noted only occasionally. Peak flow meters were used with only 5 patients, all examined by pneumologists; on the other hand, arterial blood samples for gasometric measurements were taken from 97%, although only 24% met the criteria stipulated in the guidelines. Treatment evaluated against the guidelines was incorrect in 24%, with no significant differences between pneumologists and other specialists. We conclude that: 1) the emergency clinical assessment and treatment of patients presenting with acute asthma attack is inadequate for a large proportion of patients, as the recommendations of consensual guidelines are habitually ignored, and 2) although there are differences in the management of these patients by pneumologists and other emergency room specialists, the former do not generally do a better job of following the guidelines.

Adolescent↗

PubMed1999

[A management analysis of bacterial meningitis in a hospital emergency service: the delay from the start of treatment and related factors].

OBJECTIVE: To establish the time elapsed from the patient arrival to the emergency room to the beginning of antibiotic therapy. To identify etiologic factors for treatment delay. METHODS: 73 patients diagnosed of bacterial meningitis in the emergency room and admitted to the hospital were studied. Patient characteristics as well as meningitis predisposing factors, symptoms, physical examination, laboratory data, radiological studies and previous ambulatory treatment, were recorded retrospectively. Arrival time, time expended at diagnostic procedures and time of administration of the first antibiotic dose, as well as the administration place were registered. Patients clinical evolution, and factors influencing the delay of antibiotic administration were analyzed. RESULTS: Median age was 17 years. Patient care was evenly distributed along the day, 80% had a light base risk, 29% had at least a risk factor for meningitis, 22% received antibiotic previously. Clinical presentation was classic in more than 71% of patients. Blood cultures were positive in 41%, and CSF cultures were positive in 63%, 43% of cases were related to Neisseria meningitidis, 20% Streptococcus pneumoniae and unknown bacteria in 31.5%. Computerized Tomography (CT) was performed in 9 cases. Median time from the arrival to the Emergency Room until antibiotic administration was 5 hours and 25 minutes: When antibiotics were given before Lumbar Puncture (LP), it was 2 hours and 50 minutes, 5 hours 20 minutes when therapy was started after LP, and 7 hours and 22 minutes when CT was performed before LP. The only factor showing a statistically significant relation with the time to antibiotic administration was the patient being sent by the primary care physician to the hospital with a presumptive diagnosis of bacterial meningitis (1 hour 20 minutes vs. 5 hours 51 minutes). CONCLUSION: Only a small part of bacterial meningitis cases start antibiotic treatment in the first 30 minutes. Delay is high and it increases when certain diagnostic tests are performed. Information received from the primary care physician, has the highest influence on the beginning of treatment.

Acute Disease↗

PubMed1995

[Compliance with the new model referral forms from primary care to hospital emergency services].

OBJECTIVE: To evaluate the compliance with the new model forms for referral to hospital emergency services and possible differences between urban and rural health centres, and among general practitioners and family & community medicine specialists. DESIGN: An observational, crossover study. SETTING: Health Area 1 in the province of Badajoz. PARTICIPANTS: 800 new model forms for referral, equivalent to the same number of patients, sent to the casualty department of the referral hospital. MEASUREMENTS AND MAIN RESULTS: 76.7% of the referrals came from the rural environment, and the other 23.3% from urban health centres. Gathering anamnesis and symptoms is the only criterion which exceeds 90% of the recording in both rural and urban settings, and among general practitioners and family medicine specialists. Only 23.9% of referrals (23.8% in rural health centres and 22.7% in urban ones) met the four criteria which were considered indispensable for a minimum level of compliance. These percentages were 23.2% and 31.7% when broken down for general practitioners and family medicine specialists (no significant differences). CONCLUSIONS: There was a low level of compliance with the new model form for referral: there were no statistically significant differences in compliance between rural and urban health centres, nor between general practitioners and family & community medicine specialists.

Community Medicine↗

PubMed1994

[Primary care as a determinant of the utilization of hospital emergency services].

OBJECTIVE: To study the characteristics of emergency care within Primary Care (ECPC), which determine the use of hospital emergency services (HES). DESIGN: Retrospective study. The unit of analysis was the patient attended at the HES. SETTING: Xàtiva Hospital records and data from Primary Care Management, regarding the type of ECPC and the distance from the patient's town of residence to the hospital. PATIENTS AND OTHER PARTICIPANTS: The data of all the patients, a total of 15,290 cases, attended at the HES during the first six months of 1992 were analysed. MEASUREMENTS AND MAIN RESULTS: We constructed a logistic regression model whose explicative variables were the type of ECPC and the distance to the hospital. The variable reply was the probability for each town of causing a high use of HES. We obtained a model whose predictive capacity was 82.98%, in which, independently of distance, the probability of causing a high use of HES was ordered from low to high, as follows: 1) Towns where the Primary Care Team (PCT) physically provided ongoing care in the town itself. 2) Towns attended by a normal Emergency Service (in the town itself). 3) Towns where the PCT provided ongoing care of a localised nature. 4) Towns where the PCT physically provided ongoing care in another town. The relation of distance to the use of HES was inverse. CONCLUSIONS: Distance and the different types of ECPC affect the use of HES.

Emergency Service, Hospital↗

PubMed1989

[Utilization of a hospital emergency service. Influence of the need to transfer to another location and previous medical attention].

171 cases consecutively seen in a hospital emergency service were prospectively evaluated. Several data were recorded to assess the type of care given and the need for attention in an institution with the technical resources of a hospital. These data were evaluated considering whether the user had moved from another town to receive attention and whether he had been referred by a physician or not. There were definite differences in the behavior of the user from the town where the hospital is located and the remaining users. These differences were not attributable to a different performance or evaluation from the primary care services of the several towns involved. It was concluded that, at the present time, the use of the emergency service of our hospital is significantly influenced by the decision of the user to consult the service. Factors other than the severity of the disease influence this decision.

Adolescent↗

PubMed1997