Editor’s note: Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://www.wame.org/about/policystatements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals, and are not peer reviewed or edited by Hong Kong Journal of Emergency Medicine.
Barriers and facilitators to Electronic Medical Records usage in the Emergency Centre at Komfo Anokye Teaching Hospital, Kumasi-Ghana
Gyamfi A, Mensah KA, Oduro G, Donkor P, Mock CN
Gyamfi et al. Afr J Emerg Med. 2017; 7(4): 167–171.
Introduction: The use of paper for record keeping (or a manual system) has been the order of the day in almost all health care facilities in resource poor countries. This system has presented numerous challenges, which the use of Electronic Medical Records (EMRs) seeks to address. The objectives of the study were to identify the facilitators and barriers to EMR implementation in Komfo Anokye Teaching Hospital’s (KATH) Emergency Centre (EC) and to identify lessons learned. These will help in implementation of EMR in ECs in similar settings.
Methods: This was a non-interventional, descriptive cross-sectional and purely qualitative study using a semi-structured interview guide for a study population of 24. The interviews were manually recorded and analysed thematically. EMR implementation was piloted in the EC. Some of the EC staff doubled as EMR personnel. An open-source EMR was freely downloaded and customised to meet the needs of the EC. The EMR database created was a hybrid one comprising of digital bio-data of patients and scanned copies of their paper EC records.
Results: The facilitators for utilising the system included providing training to staff, the availability of some logistics and the commitment of staff. The project barriers were funding, full-time information technology expertise, and automatic data and power backups. It was observed that with the provision of adequate human and financial resources, the challenges were overcome and the adoption of the EMR improved.
Discussion: The EMR has been a partial success. The facilitators identified in this study, namely training, provision of logistics and staff commitment, represent foundations to work from. The barriers identified could be addressed with additional funding, provision of information technology expertise, and data and power back up. It is acknowledged that lack of funding could substantially limit EMR implementation.
Annals of Emergency Medicine Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose
Frank Scheuermeyer, Christopher DeWitt, Jim Christenson, Brian Grunau, Andrew Kestler, Eric Grafstein, Jane Buxton, David Barbic, Stefan Milanovic, Reza Torkjari, Indy Sahota, Grant Innes
Published Online First: 9 March 2018. doi: 10.1016/j.annemergmed.2018.01.054
Study objective: Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose.
Methods: At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits and mortality. Primary outcome was a composite of admission and death within 24 h. Other outcomes included treatment with additional ED naloxone, development of a new medical issue while in the ED and length of stay. A prespecified subgroup analysis assessed low-risk patients with normal triage vital signs.
Results: There were 1009 uncomplicated presumed fentanyl overdose, mainly by injection. Median age was 34 years, 85% were men and 82% received out-of-hospital naloxone. One patient was hospitalised and one discharged patient died within 24 h (combined outcome 0.2%; 95% confidence interval (CI) 0.04%–0.8%). Sixteen patients received additional ED naloxone (1.6%; 95% CI 1.0%–2.6%), none developed a new medical issue (0%; 95% CI 0%–0.5%) and median length of stay was 173 min (interquartile range 101–267). For 752 low-risk patients, no patients were admitted or developed a new issue and one died postdischarge; 3 (0.4%; 95% CI 0.01%–1.3%) received ED naloxone.
Conclusion: In our cohort of ED patients with uncomplicated presumed fentanyl overdose – typically after injection – deterioration, admission, mortality and postdischarge complications appear low; the majority can be discharged after brief observation. Patients with normal triage vital signs are unlikely to require ED naloxone.
External validity of a prognostic score for acute heart failure based on the epidemiology of acute heart failure in emergency departments registry: the EAHFE-3D Scale
Susana García-Gutiérrez, José M Quintana López, Ane Antón-Ladislao, María Soledad Gallardo Rebollal, Irene Rilo Miranda, Miren Morillas Bueno, Nekane Murga Eizagaetxebarria, Ricardo Palenzuela Arocena, Esther Pulido, Irantzu Barrio Beraza, Urko Aguirre Larracoechea, Inmaculada Arostegui; en representación del grupo AHFRS
García-Gutiérrez et al. Emergencias. 2018; 30: 84–90. http://emergencias.portalsemes.org/descargar/validacin-externa-de-la-escala-eahfe3d-para-la-evaluacin-del-pronstico-en-insuficiencia-cardiaca-aguda/
Cited: García-Gutiérrez S, Quintana López JM, Antón-Ladislao A, et al. External validity of a prognostic score for acute heart failure based on the epidemiology of acute heart failure in emergency departments registry: the EAHFE-3D Scale. Emergencias 2018; 30: 84–90.
Objective: To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure.
Methods: Study of a multipurpose cohort of patients with acute heart failure in three hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood and emergency department treatments (non-invasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient’s EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department.
Results: The patient sample for score validation consisted of 717 patients with complete information. The model’s intercept was 0.5 (95% confidence interval (CI) –2.7 to 3.7) and the slope was 1.3 (95% CI 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI 0.58 to 0.94).
Conclusion: The EAHFE-3D scale’s ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice.
Essential medicines for emergency care in Africa
Morgan C Broccoli, Jennifer L Pigoga, Mulinda Nyirenda, Lee Wallis, Emilie J Calvello Hynes
Published Online First: 7 April 2018. doi: 10.1136/emermed-2017-207396
Objectives: Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.
Methods: We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.
Results: The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals) and an additional 78 for advanced facilities (e.g. tertiary centres).
Conclusion: The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.
