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Introduction: Knowledge about the relationship between symptoms, diagnoses, and mortality in emergency department (ED) patients is essential for the emergency physician to optimize treatment, monitoring, and flow. In this study, we investigated the association between symptoms and discharge diagnoses; symptoms and mortality; and we then analyzed whether the association between symptoms and mortality was influenced by other risk factors. Methods: This was a population-based, multicenter cohort study of all non-trauma ED patients ≥18 years who presented at a hospital in the Region of Southern Denmark between January 1, 2016–March 20, 2018. We used multivariable logistic regression to examine the association between symptoms and mortality adjusted for other risk factors. Results: We included 223,612 ED visits with a median patient age of 63 and even distribution of females and males. The frequency of the chief complaints at presentation were as follows: non-specific symptoms (19%); abdominal pain (16%); dyspnea (12%); fever (8%); chest pain (8%); and neurologic complaints (7%). Discharge diagnoses were symptom-based (24%), observational (hospital visit for observation or examination, 17%), circulatory (12%), or respiratory (12%). The overall 30-day mortality was 3.5%, with 1.7% dead within 0-7 days and 1.8% within 8-30 days. The presenting symptom was associated with mortality at 0-7 days but not with mortality at 8-30 days. Patients whose charts were missing documentation of symptoms (adjusted odds ratio [aOR] 3.5) and dyspneic patients (aOR 2.4) had the highest mortality at 0-7 days across patients with different primary symptoms. Patients ≥80 years and patients with a higher degree of comorbidity had increased mortality from 0-7 days to 8-30 days (aOR from 24.0 to 42.7 and 1.9 to 2.8, respectively). Conclusion: Short-term mortality was more strongly associated with patient-related factors than with the primary presenting symptom at arrival to the hospital.

The frequency of people presented in emergency departments (EDs) after self‐harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self‐harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self‐harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self‐harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self‐harming event and (3) a system of chaos. Patients admitted to the ED after self‐harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self‐harm patients and so provides chaotic patient pathways. There is a need for improved cross‐sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow‐up care between those involved in the patient's pathway and care. [ABSTRACT FROM AUTHOR]

Background: Hypokalemia is common in hospitalized patients and associated with ECG abnormalities. The prevalence and prognostic value of ECG abnormalities in hypokalemic patients are, however, not well established. Methods: The study was a multicentered cohort study, including all ault patients with an ECG and potassium level <4.4 mmol/L recorded at arrival to four emergency departments in Denmark and Sweden. Using computerized measurements from ECGs, we investigated the relationship between potassium levels and heart rate, QRS duration, corrected QT (QTc) interval, ST‐segment depressions, T‐wave flattening, and T‐wave inversion using cubic splines. Within strata of potassium levels, we further estimated the hazard ratio (HR) for 7‐day mortality, admission to the intensive care unit (ICU), and diagnosis of ventricular arrhythmia or cardiac arrest, comparing patients with and without specific ECG abnormalities matched 1:2 on propensity scores. Results: Among 79,599 included patients, decreasing potassium levels were associated with a concentration‐dependent increase in all investigated ECG variables. ECG abnormalities were present in 40% of hypokalemic patients ([K+] <3.5 mmol/L), with T‐wave flattening, ST‐segment depression, and QTc prolongation occurring in 27%, 16%, and 14%. In patients with mild hypokalemia ([K+] 3.0–3.4 mmol/L), a heart rate >100 bpm, ST‐depressions, and T‐wave inversion were associated with increased HRs for 7‐day mortality and ICU admission, whereas only a heart rate >100 bpm predicted both mortality and ICU admission among patients with [K+] <3.0 mmol/L. HR estimates were, however, similar to those in eukalemic patients. The low number of events with ventricular arrhythmia limited evaluation for this outcome. Conclusions: ECG abnormalities were common in hypokalemic patients, but they are poor prognostic markers for short‐term adverse events under the current standard of care. [ABSTRACT FROM AUTHOR]

Background: Socially marginalised people are at a substantially increased risk of diseases and typically have several contacts with the healthcare system. Health professionals at hospitals often lack the knowledge, skills, confidence, and time to provide relevant care for socially marginalised patients. Danish hospitals have implemented a social nursing initiative consisting of social nurses with specialised knowledge about marginalisation to support socially marginalised patients. Limited research into patients' perceptions of social nursing has been undertaken. Objective: To explore patients' experiences with the in‐hospital social nursing initiative. Design: A qualitative study was conducted using a phenomenological hermeneutical approach. Setting: Odense University Hospital, Denmark. Participants: Patients aged 18 years and older who had been in contact with a social nurse during hospital admission were purposely sampled. Data saturation was reached when 15 participants were recruited. Methods: In‐depth patient interviews were conducted from November 2021 to April 2022 using a semi‐structured interview guide. The interviews were transcribed verbatim and analysed using systematic text condensation. NVivo 12 software was employed for the analysis. Patient representatives were involved to validate the analysis and interpretations. Results: Three themes were identified: (1) an equal and trusting relationship, (2) receiving person‐centred care, and (3) coherence in the patient trajectory. The results show that when patients have established a relationship with a social nurse, they are willing to let her into their lives and share personal information. Patients also experience person‐centred care and coherence in their trajectory when a social nurse participated in their treatment and care. Conclusion: The findings indicate that the social nursing initiative bridges the gap between socially marginalised patients and healthcare services. [ABSTRACT FROM AUTHOR]

Background: Response time for emergency medical service units is a key performance indicator. Studies have shown reduced response time association with improved outcome for specific critical conditions. To achieve short response time, emergency vehicles utilize lights and sirens, and crews are allowed to be non‐compliant with traffic rules, posing a risk for accident. The purpose of the systematic review and meta‐analysis is to provide an overview of the current body of evidence regarding the association, if any, between ambulance and helicopter response time and major complications and mortality in patients conveyed by ambulance and/or helicopter. Our secondary aim will be to enhance knowledge in the field of criteria‐based dispatch to provide decision makers with evidence to optimize dispatch of limited resources. Research Questions: What is the association between overall emergency medical services unit response time and patient outcomes, major complications, and time‐critical conditions?What is the internal and external validity of the included literature? Methods: We plan the systematic review and meta‐analysis to be in accordance with the Cochrane Handbook and Joanna Briggs Institute Manual for Systematic Reviews. The methodology will include formulating the review questions using a Population, Exposure, and Outcome framework. Every study design is eligible, including qualitative, quantitative, and mixed‐methods designs. We will include all articles in English, Scandinavian, German, French and Portuguese in this systematic review. Results: We will publish results from the systematic review and meta‐analysis in a peer‐reviewed journal and we will present the results at scientific conferences and meetings. Results will also be available at www.ahrtemis.dk. Conclusion: We will base our conclusions on the findings of the review and meta‐analysis. [ABSTRACT FROM AUTHOR]