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Background: Due to the increase in life expectancy, both the general population and the population of patients of emergency departments (ED) are getting older. An understanding of differences, workload and resource requirements may be helpful in improving patient care. The main goal of this study was to evaluate the reasons for geriatric admissions in the ED, identify typical medical problems and assess the number of resources in order to provide more effective management. Methods: We examined 35,720 elderly patients' ED visits over the course of 3 years. The data collected included age, sex, timing and length of stay (LOS), use of various resources, endpoint (admission, discharge or death) and ICD-10 diagnoses. Results: The median age was 73 years [66–81], with more females (54.86%). There were 57.66% elderly (G1), 36.44% senile (G2) and 5.89% long-liver (G3) patients. There were more females in the older groups. The total admission rate was 37.89% (34.19% for G1, 42.21% for G2 and 47.33% for G3). The average length of the patient's stay was 150 min [81–245] (G3 180 min [108–277], G2 (162 min [92–261]) and G1 139 min [71–230]). Heart failure, atrial fibrillation and hip fracture were the most common diagnoses. Nonspecific diagnoses were common in all groups. Conclusion: The vast majority of geriatric patients required considerable resources. With increasing ages, the number of women, LOS and number of admissions increased. [ABSTRACT FROM AUTHOR]

Introduction: Emergency department (ED) patients with acute pulmonary embolism (PE) despite therapeutic anticoagulation at the time of diagnosis are uncommonly encountered and present a diagnostic and management challenge. Their characterization and outcomes are poorly described. We sought to describe the prevalence and characteristics of therapeutically anticoagulated patients among a population of patients with acute PE in a community setting and to describe treatment changes and 30-day outcomes.  Methods: From a large retrospective cohort of adults with acute, objectively-confirmed PE across 21 EDs between 01/2013 and 04/2015, we identified patients who arrived on direct oral or injectable anticoagulants, or warfarin with an initial ED international normalized ratio (INR) value ≥2.0. Patients were excluded from the larger cohort if they had received a diagnosis of venous thromboembolism (VTE) in the prior 30 days. We gathered demographic and clinical variables from electronic health records and structured manual chart review. We report discharge anticoagulation regimens and major 30-day adverse outcomes.  Results: Among 2,996 PE patients, 36 (1.2%) met study criteria. Mean age was 63 years. Eleven patients (31%) had active cancer and 25 (69%) were high risk on the PE Severity Index (Classes III-V), comparable to the larger cohort (p>0.1). Reasons for pre-arrival anticoagulation were VTE treatment or prevention (n=21), and atrial fibrillation or flutter (n=15). All patients arrived on warfarin and one was also on enoxaparin: 32 had a therapeutic INR (2.0-3.0) and four had a supratherapeutic INR (>3.0). Fifteen patients (42%) had at least one subtherapeutic INR (

Background: Ischemic heart disease (IHD) is the main cause of morbidity and mortality worldwide, and a considerable part of these patients attend to emergency departments, which increases the burden to these busy departments. The aim of this study was to develop a prediction model enabling prediction of all cause emergency department (ED) visits in patients with documented coronary stenosis in a derivation set, and then to determine its accuracy in a validation set. Methods: In a prospective study at outpatient setting of Baqiyatallah hospital, Tehran, Iran, 502 patients with IHD were followed for 6 months for observing the outcome of ED visits for all causes. They were divided in two random groups of derivation set (n = 335) and validation set (n = 167). In the derivation set, to achieve an all cause ED visits prediction model, a prediction model was reached by entering demographic data, clinical variables, somatic comorbidity (Ifudu index), level of anxiety and depression (Hospital Anxiety Depression Scale (HADS) questionnaire), and angina grade (WHO Rose Angina) to a logistic regression. Then in the validation set, the sensitivity, specificity, and the accuracy of that model was tested. Results: A novel model for prediction of all cause ED visits in IHD patients in six months was presented with gender, anxiety, WHO angina grade and somatic comorbidity as inputs. Sensitivity, specificity, and accuracy of the model were 63.0%, 68.6%, and 67.7%, respectively. Conclusions: Testing and using the achieved model is suggested to health care providers in other settings.

Background: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. Materials and Methods: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. Results: Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals Conclusions: Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork. [ABSTRACT FROM AUTHOR]

Introduction: Care transition is an important indicator for integrated care. Patients undergoing transitions from one practice setting to another are at risk for fragmented care and deficits in the quality of care. This is particularly important for patients with chronic illness given their complex continuing and persistent care needs. Gaps in care at the interface between emergency department (ED) and community services are common in Brazil. Patients are often discharged from ED without an effective care transition, resulting in increased hospitalizations, frequent ED utilization and more cost to healthcare system. The purpose of the study is to analyze care transitions of patients with chronic illness from ED to home in Brazil. Methods: A four phase sequential explanatory mixed methods study will be carried out in a large urban hospital in south Brazil. 1) Cross-cultural adaptation of the Care Transitions Measure (CTM) to Portuguese with an expert committee and 30 patients from clinical inpatient units that used a Likert-scale to assess clarity of the translated measurement; 2) Psychometric properties evaluation for test-retest reliability and internal consistency reliability (Cronbach's alpha) with a sample of with 150 patients from clinical inpatient units; 3) Evaluation of the quality of care transition using the Brazilian version of CTM with 325 patients with chronic illness discharged from ED to home by telephone interview; 4) Conduction of a focus group with ED nurses to discuss interventions to improve the quality of care transitions for patients with chronic illness. Results: Cross cultural adaptation was completed through translation to Portuguese, back translation to English and review by the expert committee. Clarity rate were greater than 80% in all items of the measurement. Patients did not make any recommendations for changes. Regarding psychometric properties of the Brazilian version of CTM, Cronbach's alpha was 0,929 and the testretest reliability showed no statistical difference in all items of the measurement (p>0,05). We are currently in process of data collection of the third phase of the study. Discussion: To our knowledge, this is the first study to investigate care transitions from ED to home in Brazil. We did an adaptation and validation of the CTM to Portuguese to evaluate care transitions of patients with chronic illness from ED to home in Brazil. This process was successful, resulting in a well understood and easily applied version of the CTM. Psychometric properties of the Brazilian version were similar to the original and other translated versions of the measurement. Conclusion: Cross cultural adaptation was completed. Results suggest that the Brazilian version of CTM can be used as a reliable and valid measure of care transitions in Brazil. Upon completion of phase 3, we will move to the next phase of the study. The results of this research will be beneficial for providers and decision-makers in evaluating and improving the quality of care transitions in the Brazilian context. It may contribute to a better coordination of transitions in care across services, as well as support changes and improvements for health system integration. [ABSTRACT FROM AUTHOR]

Introduction: The frequency of workplace violence has increased significantly across several countries, with short- and long-term effects on workers' health. Within the health care sector, nursing professionals are the most exposed to workplace violence, since they provide direct assistance to patients on a 24-hour basis., Objectives: To identify the types of occupational violence experienced by nursing professionals., Methods: This was a descriptive, quantitative study of 55 nursing professionals in the emergency unit of a public hospital. Data were collected between April and June 2018 through the Questionnaire for Workplace Violence Experienced or Witnessed by Nursing Professionals. Categorical variables were presented as frequencies and percentages, while continuous variables were described using measures of central tendency and dispersion., Results: A total of 49 (88.9%) participants had experienced workplace violence, with 21 (38%) suffering verbal abuse; 14 (25.4%) experiencing mobbing; 6 (11%) reporting physical violence; 5 (9.1%) suffering sexual harassment; and 3 (5.4%) reporting racial discrimination. Furthermore, 44 (90%) of these individuals reported that the incidents of violence could have been prevented., Conclusions: The types of violence observed included physical aggression, verbal abuse, sexual harassment and racial discrimination, with verbal abuse being the most commonly reported. These acts were perpetrated by patients and their families, as well as colleagues and supervisors. Violence prevention strategies should be implemented in institutions in order to provide a safe working environment., Competing Interests: Conflicts of interest: None

Aim: Transporting critically ill patients outside of disaster-affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake., Methods: Japan was divided into three areas based on the level of predicted damage (definitely, possibly, and non-affected areas). A survey of DMATs and the locations of emergency base hospitals and intensive care units (ICUs) in each area was carried out, and the ability to support disaster areas was investigated. Next, a survey of wide-area medical transport by Self-Defense Force aircraft and the medical transport abilities of helicopter ambulances was carried out. The numbers of ICU beds in each area were compared, and the capacity to accept patients was investigated. Finally, subjects for further study were examined., Results: The number of DMATs that could be sent from non-affected areas was insufficient. The number of patients that can be transported by Self-Defense Force aircraft and helicopter ambulance during the first 3 days was determined to be 1,443. The number of patients that can be accepted by ICUs in non-affected areas was insufficient. A system needs to be developed to provide medical treatment for critically ill patients within disaster areas during the acute phase. This will require DMAT operational reforms and the creation of logistics systems such as the supply of resources for earthquake-reinforced hospitals., Conclusion: In addition to patient transport, systems to provide medical care inside disaster-affected areas are needed.