- Email: [email protected]
96: The Usefulness of Ultrasound-Assisted Lumbar Puncture in the Emergency Center: Comparison With Classic Lumbar Puncture
ICEM 2008 Scientific Abstract Program 2. It was proved by the literature review that there is a possibility of complying with ISO 9000, ISO 17025 & ISO 15189 in an integrated QMS, due to similarities between them in management and quality assurance issues. Conclusion: As a result of the study a major recommendation was given to the management of Saudia Medical Services Laboratory to view the results of the survey and discuss each area. It is important to start establish and document the main and support process procedures of the lab, it was also recommended to establish Quality Department that handle all quality assurance process at the lab in addition to conducting training and awareness for Quality Safety and Security. This study could be replicated by other quality management standards such as ISO 17025, ISO 9000 or OHSAS 18000.
95
Occupational Hazards of Emergency Medicine in Iran
Nejati A, Khalaj S, Shakori A, Khademhosseini P/University of Tehran, Tehran, Iran (Islamic Republic of)
Study Objective: Emergency medicine is a new specialty in Iran. The first residency training program started seven years ago. The residency program takes three years to complete. Currently, there are four emergency medicine training centers in Iran. Although first emergency physicians graduated and started their work four years ago, no study has documented the occupational perils of emergency department practice in our country yet. In this survey, our objective was to document the occupational hazards of emergency department physicians and staff. Methods: There are various articles about occupational hazards of emergency department practice. Considering the rules of our country, we accepted the following items as occupational hazard. Data was collected from official records of Imam Khomeini hospital’s emergency department, Tehran University of Medical Sciences. Our survey was performed in August 2007. Results: During the 30 day study period, 3267 patients visited the emergency department from which 1013 were admitted. There were 143 CPRs, from which 62 were unsuccessful. There were 5 documented HIV positive patients, 6 documented HCV positive patients, 6 documented HBS positive patients, 2 documented active Tuberculosis patients and 3 documented Meningitis patients. Two patients were prisoners. 116 of patients admitted needed ICU and 40 needed CCU, and because the lack of sufficient beds, most of them got ICU and CCU care in emergency department for a few days. Sixty trauma patients were brought to our department by Helicopter Emergency Service. There were 200 bedside portable radiographs. There were 41 end stage cancer patients and 38 ESRD patients needing emergent dialysis. Conclusion: In our country, medical specialties such as Infectious disease and Forensic medicine are classified as hazardous occupations. Taking into account the number of active night shifts by emergency physicians and the aforementioned data, it seems that emergency department practice has its own hazards and should be classified as a hazardous occupation too.
96
The Usefulness of Ultrasound-Assisted Lumbar Puncture in the Emergency Center: Comparison With Classic Lumbar Puncture
Lee WS, Jeong WJ/Chungnam National University Hospital, Daejeon, Republic of Korea
Study Objectives: To evaluate the usefulness of ultrasound (US) assisted lumbar puncture in the emergency department Methods: This was a prospective randomized controlled trial. We enrolled patients who need lumbar puncture from May to August 2007 in the Emergency Care Center of Chungnam National University Hospital. Patients were randomized to undergo lumbar puncture using classic method or ultrasound assisted method. Data collected included age, sex, height, underline disease of vertebrate, weight, frequency of attempting procedure, procedure time, failed lumbar puncture, and traumatic lumbar puncture. Results: Sixty-one patients enrolled in the study. Thirty-two patients got classic lumbar puncture and 29 patients got ultrasound-assisted lumbar puncture. There were no differences in mean age, height, weight between the groups. It took 6 of 32 failed puncture with classic method versus 1 to 29 with ultrasoundassisted method (P⫽0.07), and 3 of 32 traumatic puncture with classic method versus 1 to 29 with ultrasound assisted method (P⫽0.35). It took 8.56⫾8.43 minutes to procedure with classic method versus 8.21⫾6.36 minutes with ultrasound-assisted method (P⫽0.85). The frequency of attempting procedure is
500 Annals of Emergency Medicine
2.31⫾1.77 to procedure with classic method versus 1.62⫾1.05 with ultrasoundassisted method (P⫽0.66). But at the elderly patients especially older than 60 years old, the frequency of attempting procedure is 4.00⫾2.51 to procedure with classic method versus 1.57⫾0.54 with ultrasound-assisted method (P⫽0.03), and it took 4 of 32 failed puncture with classic method versus 0 to 29 with ultrasound-assisted method. Conclusion: It is not useful for emergency physicians to attempt ultrasoundassisted lumbar puncture in the emergency department at all ages. But at the elderly patients especially older than 60 years old, it is useful for emergency physicians to attempt ultrasound-assisted lumbar puncture.
97
Impact of the Effectiveness of a Chest Pain Awareness Campaign on Emergency Department Attendances and Ambulance Calls
Athar M, Patel M, Holder R, Cooke MW/Heart of England NHS Foundation Trust, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Warwick Medical School, Coventry, United Kingdom
Background: The British Heart Foundation’s Doubt Kills Campaign aims to increase awareness of heart attack symptoms, to reduce out-of-hospital mortality from MI and to reduce the time delay in seeking help in patients particularly targeting South Asian communities. This Campaign started in Nov 2006 and will be continuing till Oct 2007. Study Objective: To quantify the effects of this campaign on the emergency departments and ambulance services with respect to numbers presenting with chest pain and detection of cardiac disease. Methods: Patients with a presenting complaint of chest pain or associated symptoms were included. The primary outcome is the number of patients who attended with chest pain before and during the campaign. Subgroup analysis was undertaken by eventual diagnosis, age, sex, ethnic origin, investigations undertaken, speciality consultations and mode of arrival. Analysis is undertaken by comparison of means before and after including multivariate analysis and also using statistical process control. Ambulance service data has also been analysed in a similar manner for patient presenting with dispatch codes of chest pain. Results: The average attendances changed from 712 per month to 884 per month, mostly in the non cardiac group (345 vs 494; p⫽0.004) rather than the cardiac (366 vs 398; p⫽0.163). The increase was more marked in the south Asian population, those discharged with a non cardiac diagnosis, those not referred to in patient teams. Statistical process control demonstrates that the total number of chest pains and those of non-cardiac origin have shown an increase outside normal variation whereas those with cardiac pain have only shown changes compatible with background variation with time. This change was however only present for four months and numbers then returned to the pre-campaign levels. The ambulance data shows an increase in the time period after the start of the campaign but this appears to reflect a seasonal trend in previous years and therefore may not be causally related to the campaign. Discussion: The campaign seems to have had minimal effect on increasing the uptake of those with cardiac symptoms at the expense of many more patients presenting to the ED but the effects were short lived. The effect on ambulances was less marked.
98
Declining Resident Productivity Over Time in the Emergency Department
Jeanmonod R, Brook C, Winther M, Pathak S, Boyd M/Albany Medical College, Albany, NY
Background: It has been established in the Emergency Medicine (EM) literature that residents are able to evaluate more patients per hour (productivity) as they progress through training. Whether resident productivity varies as a function of accumulated time in the emergency department during the course of a given shift has not been assessed. This information is important, as it can be used to better understand residents’ contribution to patient flow in an emergency department (ED), and can help delineate optimal staffing patterns to assist with patient flow. Study Objectives: To determine whether there is a difference or pattern in resident productivity over time during a shift. Methods: This is a retrospective chart review of patients evaluated in the ED by first, second, and third year residents in a 65,000 volume tertiary care center. All ED
Volume , . : April
95
Occupational Hazards of Emergency Medicine in Iran
Nejati A, Khalaj S, Shakori A, Khademhosseini P/University of Tehran, Tehran, Iran (Islamic Republic of)
Study Objective: Emergency medicine is a new specialty in Iran. The first residency training program started seven years ago. The residency program takes three years to complete. Currently, there are four emergency medicine training centers in Iran. Although first emergency physicians graduated and started their work four years ago, no study has documented the occupational perils of emergency department practice in our country yet. In this survey, our objective was to document the occupational hazards of emergency department physicians and staff. Methods: There are various articles about occupational hazards of emergency department practice. Considering the rules of our country, we accepted the following items as occupational hazard. Data was collected from official records of Imam Khomeini hospital’s emergency department, Tehran University of Medical Sciences. Our survey was performed in August 2007. Results: During the 30 day study period, 3267 patients visited the emergency department from which 1013 were admitted. There were 143 CPRs, from which 62 were unsuccessful. There were 5 documented HIV positive patients, 6 documented HCV positive patients, 6 documented HBS positive patients, 2 documented active Tuberculosis patients and 3 documented Meningitis patients. Two patients were prisoners. 116 of patients admitted needed ICU and 40 needed CCU, and because the lack of sufficient beds, most of them got ICU and CCU care in emergency department for a few days. Sixty trauma patients were brought to our department by Helicopter Emergency Service. There were 200 bedside portable radiographs. There were 41 end stage cancer patients and 38 ESRD patients needing emergent dialysis. Conclusion: In our country, medical specialties such as Infectious disease and Forensic medicine are classified as hazardous occupations. Taking into account the number of active night shifts by emergency physicians and the aforementioned data, it seems that emergency department practice has its own hazards and should be classified as a hazardous occupation too.
96
The Usefulness of Ultrasound-Assisted Lumbar Puncture in the Emergency Center: Comparison With Classic Lumbar Puncture
Lee WS, Jeong WJ/Chungnam National University Hospital, Daejeon, Republic of Korea
Study Objectives: To evaluate the usefulness of ultrasound (US) assisted lumbar puncture in the emergency department Methods: This was a prospective randomized controlled trial. We enrolled patients who need lumbar puncture from May to August 2007 in the Emergency Care Center of Chungnam National University Hospital. Patients were randomized to undergo lumbar puncture using classic method or ultrasound assisted method. Data collected included age, sex, height, underline disease of vertebrate, weight, frequency of attempting procedure, procedure time, failed lumbar puncture, and traumatic lumbar puncture. Results: Sixty-one patients enrolled in the study. Thirty-two patients got classic lumbar puncture and 29 patients got ultrasound-assisted lumbar puncture. There were no differences in mean age, height, weight between the groups. It took 6 of 32 failed puncture with classic method versus 1 to 29 with ultrasoundassisted method (P⫽0.07), and 3 of 32 traumatic puncture with classic method versus 1 to 29 with ultrasound assisted method (P⫽0.35). It took 8.56⫾8.43 minutes to procedure with classic method versus 8.21⫾6.36 minutes with ultrasound-assisted method (P⫽0.85). The frequency of attempting procedure is
500 Annals of Emergency Medicine
2.31⫾1.77 to procedure with classic method versus 1.62⫾1.05 with ultrasoundassisted method (P⫽0.66). But at the elderly patients especially older than 60 years old, the frequency of attempting procedure is 4.00⫾2.51 to procedure with classic method versus 1.57⫾0.54 with ultrasound-assisted method (P⫽0.03), and it took 4 of 32 failed puncture with classic method versus 0 to 29 with ultrasound-assisted method. Conclusion: It is not useful for emergency physicians to attempt ultrasoundassisted lumbar puncture in the emergency department at all ages. But at the elderly patients especially older than 60 years old, it is useful for emergency physicians to attempt ultrasound-assisted lumbar puncture.
97
Impact of the Effectiveness of a Chest Pain Awareness Campaign on Emergency Department Attendances and Ambulance Calls
Athar M, Patel M, Holder R, Cooke MW/Heart of England NHS Foundation Trust, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Warwick Medical School, Coventry, United Kingdom
Background: The British Heart Foundation’s Doubt Kills Campaign aims to increase awareness of heart attack symptoms, to reduce out-of-hospital mortality from MI and to reduce the time delay in seeking help in patients particularly targeting South Asian communities. This Campaign started in Nov 2006 and will be continuing till Oct 2007. Study Objective: To quantify the effects of this campaign on the emergency departments and ambulance services with respect to numbers presenting with chest pain and detection of cardiac disease. Methods: Patients with a presenting complaint of chest pain or associated symptoms were included. The primary outcome is the number of patients who attended with chest pain before and during the campaign. Subgroup analysis was undertaken by eventual diagnosis, age, sex, ethnic origin, investigations undertaken, speciality consultations and mode of arrival. Analysis is undertaken by comparison of means before and after including multivariate analysis and also using statistical process control. Ambulance service data has also been analysed in a similar manner for patient presenting with dispatch codes of chest pain. Results: The average attendances changed from 712 per month to 884 per month, mostly in the non cardiac group (345 vs 494; p⫽0.004) rather than the cardiac (366 vs 398; p⫽0.163). The increase was more marked in the south Asian population, those discharged with a non cardiac diagnosis, those not referred to in patient teams. Statistical process control demonstrates that the total number of chest pains and those of non-cardiac origin have shown an increase outside normal variation whereas those with cardiac pain have only shown changes compatible with background variation with time. This change was however only present for four months and numbers then returned to the pre-campaign levels. The ambulance data shows an increase in the time period after the start of the campaign but this appears to reflect a seasonal trend in previous years and therefore may not be causally related to the campaign. Discussion: The campaign seems to have had minimal effect on increasing the uptake of those with cardiac symptoms at the expense of many more patients presenting to the ED but the effects were short lived. The effect on ambulances was less marked.
98
Declining Resident Productivity Over Time in the Emergency Department
Jeanmonod R, Brook C, Winther M, Pathak S, Boyd M/Albany Medical College, Albany, NY
Background: It has been established in the Emergency Medicine (EM) literature that residents are able to evaluate more patients per hour (productivity) as they progress through training. Whether resident productivity varies as a function of accumulated time in the emergency department during the course of a given shift has not been assessed. This information is important, as it can be used to better understand residents’ contribution to patient flow in an emergency department (ED), and can help delineate optimal staffing patterns to assist with patient flow. Study Objectives: To determine whether there is a difference or pattern in resident productivity over time during a shift. Methods: This is a retrospective chart review of patients evaluated in the ED by first, second, and third year residents in a 65,000 volume tertiary care center. All ED
Volume , . : April