Editor’s note: The 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/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
Annals of Emergency Medicine
The time is now: racism and the responsibility of emergency medicine to be antiracist
Nicole M Franks, MD, Katrina Gipson, MD, MPH, Sheri-Ann Kaltiso, MD, Anwar Osborne, MD, MPA, Sheryl L Heron, MD, MPH
Ann Emerg Med 2021
doi:10.1016/j.annemergmed.2021.05.003
The COVID-19 pandemic has shed light on the ongoing pandemic of racial injustice. In the context of these twin pandemics, emergency medicine organisations are declaring that ‘Racism is a Public Health Crisis’. Accordingly, we are challenging emergency clinicians to respond to this emergency and commit to being antiracist. This courageous journey begins with naming racism and continues with actions addressing the intersection of racism and social determinants of health that result in health inequities. Therefore, we present a social-ecological framework that structures the intentional actions that emergency medicine must implement at the individual, organisational, community, and policy levels to actively respond to this emergency and be antiracist.
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria and the Rwanda Emergency Care Association
Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa
Mashao K, Heyns T, White Z
Afr J Emerg Med 2021; 11(2): 237–241
doi:10.1016/j.afjem.2021.02.002
Introduction: Globally, length of stay of patients in emergency departments remains a challenge. Remaining in the emergency department for > 12 h increases health care costs, morbidity and mortality rates and leads to crowding and lower patient satisfaction. The aim of this research was to describe the areas of delay related to prolonged length of stay in the emergency department of an academic hospital.
Methods: A quantitative retrospective study was done. The Input-Throughput-Output model was used to identify the areas of patients' journey through the emergency department. The possible areas of delay where then described. Using systematic sampling, a total of 100 patient files managed in an emergency department of an academic hospital in South Africa were audited over a period of 3 months. Descriptive statistics and regression analysis was used to analyse data.
Results: The mean length of stay of patients in the emergency department was 73 h 49 min. The length of stay per phase was: input (3 h 17 min), throughput (16 h 25 min) and output (54 h 7 min). A strong significant relationship found between the length of stay and the time taken between disposition decision (throughput phase) disposition decision to admission or discharge of patients from the ED (output phase) (p < 0.05).
Conclusion: The output phase was identified as the longest area of delay in this study, with the time taken between disposition decision to admission or discharge of patients from the ED (patients waiting for inpatient beds) as the main significant area of delay.
Reproduced with permission
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
ED occupancy as a single measure has similar predictive accuracy to complex crowding scores and is easily generalizable to diverse emergency departments. Real-time tracking of this simple indicator could be used to prompt investigation and implementation of crowding interventions.
Esli Osmanlliu, Matthew Slimovitch, Olivier Drouin, Nathalie Lucas, Jocelyn Gravel, Nathalie Gaucher
Can J Emerg Med 2021
doi:10.1007/s43678-021-00087-x
Background: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach.
Methods: This was a cross-sectional study, conducted in a tertiary paediatric ED. We investigated patient and parent perspectives on a newly implemented parental short-acting beta-agonist administration programme. A convenience sample of families participating in this programme was approached for study enrolment. The primary outcome was the proportion of parents and children who were satisfied with the programme. We also evaluated the programme’s safety and impact on asthma education as reported by parents.
Results: From February 2019 to March 2020, 72 of 74 (97%) families approached for enrolment participated in the survey. A vast majority (95%) of parents appreciated the programme and 93% would participate again. Among children > 7 years, 86% preferred receiving inhaled short-acting beta-agonist by their parents rather than by a healthcare provider. Nearly all parents (96%) found the programme to be ‘safe’ or ‘very safe’. Some participants reported improvements in their inhaler administration technique (25%) and ability to recognise their child’s respiratory distress (25%).
Conclusion: A novel parental short-acting beta-agonist administration programme in the paediatric ED was widely appreciated by participating families. Parents perceived it as being safe, educational, and contributing to their child’s comfort.
Keywords: Short-acting beta agonist, medication administration, parental administration, paediatric, asthma, emergency department
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
Emergency department occupancy is useful as a simple real-time measure of crowding
Robin Clouston, Paul Atkinson, Donaldo D Canales, Jacqueline Fraser, Dylan Sohi, Scott Lee, Michael Howlett
Can J Emerg Med 2021
doi:10.1007/s43678-021-00098-8
Introduction: Emergency department (ED) crowding compromises patient outcomes. Existing crowding measures are complex and difficult to use in real-time. This study evaluated readily available single flow variables as crowding measures.
Methods: Over 2 weeks in a tertiary Canadian ED, we recorded the following potential crowding measures during 168 consecutive 2-hour study intervals: total ED patients (census), patients in beds, patients in waiting rooms, patients in treatment areas awaiting MD assessment; number of inpatients boarding, and ED occupancy. We also calculated four complex crowding scores – NEDOCS, EDWIN, ICMED, and a local modification of NEDOCS. We performed ROC analyses to assess the predictive validity of these measures against a reference standard of physician perception of crowding.
Results: We gathered data for 144 (63.9%) of 168 study intervals. ED census correlated strongly with crowding (AUC = 0.82, 95% CI 0.76–0.89), as did ED occupancy (AUC = 0.75, 95% CI 0.66–0.83). Their performance was similar to NEDOCS (AUC = 0.80) and to the local modification of NEDOCS (AUC = 0.83).
Conclusion: ED occupancy as a single measure has similar predictive accuracy to complex crowding scores and is easily generalizable to diverse emergency departments. Real-time tracking of this simple indicator could be used to prompt investigation and implementation of crowding interventions.
Keywords: Crowding, emergency department
Emergency Medicine Journal Nov 2021 Abstract
Adaptation of ED design layout during the COVID-19 pandemic: a national cross-sectional survey
Douillet D, Saloux T, Ravon P, Morin F, Moumneh T, Carneiro B, Roy PM, Savary D
doi:10.1136/emermed-2020-211012
Background: The aim was to describe the organisational changes in French EDs in response to the COVID-19 pandemic with regard to architectural constraints and compare with the recommendations of the various bodies concerning the structural adjustments to be made in this context.
Methods: As part of this cross-sectional study, all heads of emergency services or their deputies were contacted to complete an electronic survey. This was a standardised online questionnaire consisting of four parts: characteristics of the responding centre, creation of the COVID-19 zone and activation of the hospital’s emergency operations plan, flow and circulation of patients and, finally, staff management. Each centre was classified according to its workload related to COVID-19 and its size (university hospital centre, high-capacity hospital centre and low-capacity hospital centre). The main endpoint was the frequency of implementation of international guidelines for ED organisation.
Results: Between 11 May and 20 June 2020, 57 French EDs completed the online questionnaire and were included in the analysis. Twenty-eight EDs were able to separate patient flows into two zones: high and low viral density (n = 28/57, 49.1%). Of the centres included, 52.6% set up a specific triage area for patients with suspected COVID-19 (n = 30/57). Whereas, in 15 of the EDs (26.3%), the architecture made it impossible to increase the surface area of the ED.
Conclusion: All EDs have adapted, but many of the changes recommended for the organisation of ED could not be implemented. ED architecture constrains adaptive capacities in the context of COVID-19.
