Reciprocal Abstract Publication

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 Abstracts are reproduced as published in the respective participating journals, and are not peer reviewed or edited by Hong Kong Journal of Emergency Medicine.

Challenges relating to the inter-facility transport of high acuity paediatric cases

Vincent-Lambert C, Wade G

Afr J Emerg Med 2018;8(1):29-33 https://doi.org/10.1016/j.afjem.2017.12.001

Introduction: The motivation for this study came from anecdotal reports and observations that there was a potential need for improvement to the systems that support inter-facility transfers of high acuity paediatric cases between referring and receiving facilities in Johannesburg, South Africa. In this exploratory study, we formally document and describe challenges being experienced by members of the healthcare team in facilitating the inter-facility transport of high acuity paediatric cases.

Methods: A qualitative, explorative design was applied, making use of interviews with purposefully-identified role players involved in paediatric transportation and care. Verbatim transcripts from audio recorded interviews underwent content analysis to allow for the identification of common categories.

Results: Participants described a number of challenges, which included time delays, lack of qualified ambulance personnel, poor communication between role players, and lack of appropriate equipment.

Discussion: There are significant challenges experienced by members of the healthcare team with regard to inter-facility transport of high acuity paediatric and neonatal cases in Johannesburg, South Africa. Whilst we acknowledge the African context and resource constrained setting, health systems managers need to explore the feasibility of establishing dedicated and suitably resourced retrieval teams who specialise in the transfer of high acuity paediatric and neonatal patients in order to improve quality of care and overall patient outcomes in this population.

Annals of Emergency Medicine

(The print version of this article has been scheduled for September 2018)

Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department

Angela M. Gerolamo, Annemarie Jutel, Danielle Kovalsky, Alexzandra Gentsch, Amanda M.B. Doty, Kristin L. Rising

Study objective: Although diagnosis is a valuable tool for health care providers, and often the reason patients say they are seeking care, it may not serve the same needs for patients as for providers. The objective of this study is to explore what patients specifically want addressed when seeking a diagnosis at their emergency department (ED) visit. We propose that understanding these needs will facilitate a more patient-centered approach to acute care delivery.

Methods: This qualitative study uses semistructured telephone interviews with participants recently discharged from the ED of a large urban academic teaching hospital to explore their expectations of their ED visit and postdischarge experiences.

Results: Thirty interviews were analyzed. Many participants reported wanting a diagnosis as a primary reason for seeking emergency care. When further asked to identify the functions of a diagnosis, they described wanting an explanation for their symptoms, treatment and guidance for symptoms, and clear communication about testing, treatment, and diagnosis. For many, a diagnosis was viewed as a necessary step toward achieving these goals.

Conclusion: Although diagnosis may not be a feasible outcome of every acute care visit, addressing the needs associated with seeking a diagnosis may be achievable. Reframing acute care encounters to focus on addressing specific patient needs, and not just identifying a diagnosis, may lead to more effective transitions home and improved patient outcomes.

Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure

Francisco Javier Martín-Sánchez, Esther Rodríguez-Adrada, María Teresa Vidán, Pablo Díez Villanueva, Guillermo Llopis García, Juan González del Castillo, Miguel Alberto Rizzi, Aitor Alquézar, Sergio Herrera Mateo, Pascual Piñera, José Andrés Sánchez Nicolás, Paula Lázaro Aragues, Pere Llorens, Pablo Herrero, Javier Jacob, Víctor Gil, Cristina Fernández, Héctor Bueno, Òscar Miró

http://emergencias.portalsemes.org/descargar/impacto-de-las-variables-geritricas-en-la-mortalidad-a-30-das-de-los-ancianos-atendidos-por-insuficiencia-cardiaca-aguda/

Cited: Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Díez Villanueva P, Llopis García G, González Del Castillo J, et al. Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias. 2018;30:149-55.

Objective: To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF).

Methods: Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days.

Results: We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0–4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9–3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0–3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0–4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9–11.4; P=.01).

Conclusions: Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.