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Minor trauma: A major contributor to emergency department workload
RESEARCH FORUM ABSTRACTS
Table, abstract 384.
General Mean total ED visits per year Pediatrics Mean No. of pediatric visits per year No. of programs with separate pediatric area No. of programs with specialized pediatric staff Low-severity areas Mean No. of low-severity visits per year No. of programs with separate lowseverity area Staffing of low-severity area by: Physicians trained in emergency medicine Physicians not trained in emergency medicine Physician assistants Residents Other staff Observation units Total No. of programs currently operating observation unit Mean observation unit visits per year (at programs with observation units) No. of programs with separate observation unit shifts
Table, abstract 385. Cont'd 1998
1995
62,904
61,130
12,351 32/70 (46%)
17,672 33/76 (43%)
16/70 (23%)
30/76 (39%)
12,003 56/70 (80%)
17,028 56/76 (74%)
34/70 programs (49%) 15/70 programs (23%)
Departmental funding sources cont'd Graduate medical education allotments Government support Other sources Salary incentive components Clinical productivity Research productivity Teaching evaluations Administrative productivity Departmental productivity Hospital productivity None
3% 12% 2% 46/70 programs 41/70 42/70 48/70 36/70 30/70 12/70
86 Workload Minor Trauma: A Major Contributorto Emergency Department
25/70 programs (36%) 26/70 programs (37%) 7/70 programs (10%)
ThamKY, SeowE, Wong HP/TanTockSengHospital,Singapore
24/70 (34%) 1,786 2/70 (03%)
85
Academic Emergency Department FundingSources and Incentives: Results Fromthe 1998-1999SAEM Emergency Medicine Faculty Salary Survey KristalSL, MarxJA, RandalI-KristalKA, ThompsonBM/HenryFordHospital,GraceHospital, Wayne State University,Detroit,MI; CarolinasMedical Center,Charlotte,NC Study objective: The Society for Academic Emergency Medicine (SAEM) conducted a survey of emergency medicine faculty salaries, benefits, work hours, incentives, funding sources, and department demographics for all 1998 Residency Review Committee-Emergency Medicine accredited programs. Seventy-one (59%) of 120 accredited programs responded yielding useable data on 70 programs from all 4 Association of American Medical Colleges regions. Methods: Responses were collected by SAEM and blinded from the investigators. Program and faculty data were entered into a customized version of Filemaker Pro, a relational database program with a builtqn statistical package. Program demographic data were evaluated with regard to departmental funding sources and incentive components contributing to individual salaries. Results: The results are shown in the Table. Conclusion: Collection of professional charges, as a percentage of total department funding sources, varies directly with salaries paid. Programs relying entirely on government support as a funding source pay salaries -29% below those paid at the remaining programs. The 12 programs reporting no salary incentive components pay salaries only 2.6% below the remaining programs that do use incentives.
Study objective: To determine the epidemiology of minor trauma seen in the emergency department. Methods: All consecutive patients older than 15 years who presented to the ED of an urban public hospital in Singapore with trauma-related complaints were surveyed. Interviews were conducted with a closed-ended questionnaire from December l, 1998, to March 31, 1999. Data collected were those of demographic, nature of injury, ambulance care, ED care, and disposition. Results: The total ED attendance was 35,653 and 8,071 (22.6%) were traumarelated complaints. Of these 8,071 patients, 72.6% were men, and the ethnic group breakdown was 60.5% Chinese, 17% lndians, 8.8% Malays, and 13.6% others. Singapore citizens and permanent residents represented 72.6%, Malaysians 5.5%, and other foreigners 21.8%. The mean age was 39.1 years (95% confidence interval [CI] 38.7 to 39.6). Although the mean time interval between injury and presentation was 0.96 days (95% CI 0.86 to 1.06), most patients (72.3%) sought treatment on the same day of injury. Blunt trauma contributed to 89.1%, penetrating 8.7%, and b u m s 0.8%. Workplace accidents represented 26.7%, home accidents 25.2%, road accidents 22.5%, accidents at common area (eg, parks) 16.4%, and sports accidents 3.7% of injuries. Falls of less than 2 m contributed to 35.6% of cases, low-impact trauma 26.8%, vehicle accidents i9.1%, domestic violence 2%, and other assauh 8.1%. Of the trauma cases, 22% were brought to the ED by ambulance with 0.7% as "standby" cases. Most patients were discharged after treatment in the ED with only 21.6% admitted. Of those discharged, 43.7% sustained contusions, 24.5% had minor open wounds, 12.3% had abrasions, 9% had fractures or dislocations of the upper limb, 4.7% had fractures of the lower limb, and 1.1% had burns. Using the Abbreviated lnjury Scale (AIS) 1990 version, the mean severity score was 1.16 (95% CI 1.15 to 1.17) for the discharged patients. A mean of 4.39 days (95% CI 4.29 to 4.49) of sick leave was given to the discharged patients. After discharge from the ED, 49% did not require review, 22.4% were referred to primary health care doctors, 22.2% were referred to the orthopedic outpatient clinic, and 6.2% to other specialist outpatient clinics. Conclusion: Trauma-related complaints contributed to more than one fifth of the ED workload. Most of these were minor trauma with low AIS score. After treatment in the ED, more than 75% of patients were discharged. Of those discharged, almost half did not require any review. The injuries of this group of patients probably could have been treated successfully by primary health care doctors without requiring ED services.
87 Abdominal Documentation Deficiencies in the Evaluation of Nontraumatic Pain: Effects of a Structured Template
Table, abstract 385.
McMahan SD, BudererNF, KingRW, PlewaMC/St. VincentMercy MedicalCenter,Toledo,OH
Departmental funding sources Collections of professional charges Hospital management contract University support Grants and other contracts
53% 20% 7% 3% Cont'd
S 98
Study objectives: To compare the completeness of documentation of emergency physician records of patients with acute, nontraumatic abdominal pain before and 1 month after instituting the use of a structured template charting system. Methods: A retrospective records review of 165 (before) and 113 (after) patients age older than 5 years with a chief complaint of acute, nontraumatic abdominal pain treated in an urban teaching hospital emergency department. Excluded were patients with chronic or recurrent abdominal pain or evaluation by non-emergency physicians.
ANNALS OF EMERGENCY MEDICINE
34:4 OCTOBER 1999, PART 2
Table, abstract 384.
General Mean total ED visits per year Pediatrics Mean No. of pediatric visits per year No. of programs with separate pediatric area No. of programs with specialized pediatric staff Low-severity areas Mean No. of low-severity visits per year No. of programs with separate lowseverity area Staffing of low-severity area by: Physicians trained in emergency medicine Physicians not trained in emergency medicine Physician assistants Residents Other staff Observation units Total No. of programs currently operating observation unit Mean observation unit visits per year (at programs with observation units) No. of programs with separate observation unit shifts
Table, abstract 385. Cont'd 1998
1995
62,904
61,130
12,351 32/70 (46%)
17,672 33/76 (43%)
16/70 (23%)
30/76 (39%)
12,003 56/70 (80%)
17,028 56/76 (74%)
34/70 programs (49%) 15/70 programs (23%)
Departmental funding sources cont'd Graduate medical education allotments Government support Other sources Salary incentive components Clinical productivity Research productivity Teaching evaluations Administrative productivity Departmental productivity Hospital productivity None
3% 12% 2% 46/70 programs 41/70 42/70 48/70 36/70 30/70 12/70
86 Workload Minor Trauma: A Major Contributorto Emergency Department
25/70 programs (36%) 26/70 programs (37%) 7/70 programs (10%)
ThamKY, SeowE, Wong HP/TanTockSengHospital,Singapore
24/70 (34%) 1,786 2/70 (03%)
85
Academic Emergency Department FundingSources and Incentives: Results Fromthe 1998-1999SAEM Emergency Medicine Faculty Salary Survey KristalSL, MarxJA, RandalI-KristalKA, ThompsonBM/HenryFordHospital,GraceHospital, Wayne State University,Detroit,MI; CarolinasMedical Center,Charlotte,NC Study objective: The Society for Academic Emergency Medicine (SAEM) conducted a survey of emergency medicine faculty salaries, benefits, work hours, incentives, funding sources, and department demographics for all 1998 Residency Review Committee-Emergency Medicine accredited programs. Seventy-one (59%) of 120 accredited programs responded yielding useable data on 70 programs from all 4 Association of American Medical Colleges regions. Methods: Responses were collected by SAEM and blinded from the investigators. Program and faculty data were entered into a customized version of Filemaker Pro, a relational database program with a builtqn statistical package. Program demographic data were evaluated with regard to departmental funding sources and incentive components contributing to individual salaries. Results: The results are shown in the Table. Conclusion: Collection of professional charges, as a percentage of total department funding sources, varies directly with salaries paid. Programs relying entirely on government support as a funding source pay salaries -29% below those paid at the remaining programs. The 12 programs reporting no salary incentive components pay salaries only 2.6% below the remaining programs that do use incentives.
Study objective: To determine the epidemiology of minor trauma seen in the emergency department. Methods: All consecutive patients older than 15 years who presented to the ED of an urban public hospital in Singapore with trauma-related complaints were surveyed. Interviews were conducted with a closed-ended questionnaire from December l, 1998, to March 31, 1999. Data collected were those of demographic, nature of injury, ambulance care, ED care, and disposition. Results: The total ED attendance was 35,653 and 8,071 (22.6%) were traumarelated complaints. Of these 8,071 patients, 72.6% were men, and the ethnic group breakdown was 60.5% Chinese, 17% lndians, 8.8% Malays, and 13.6% others. Singapore citizens and permanent residents represented 72.6%, Malaysians 5.5%, and other foreigners 21.8%. The mean age was 39.1 years (95% confidence interval [CI] 38.7 to 39.6). Although the mean time interval between injury and presentation was 0.96 days (95% CI 0.86 to 1.06), most patients (72.3%) sought treatment on the same day of injury. Blunt trauma contributed to 89.1%, penetrating 8.7%, and b u m s 0.8%. Workplace accidents represented 26.7%, home accidents 25.2%, road accidents 22.5%, accidents at common area (eg, parks) 16.4%, and sports accidents 3.7% of injuries. Falls of less than 2 m contributed to 35.6% of cases, low-impact trauma 26.8%, vehicle accidents i9.1%, domestic violence 2%, and other assauh 8.1%. Of the trauma cases, 22% were brought to the ED by ambulance with 0.7% as "standby" cases. Most patients were discharged after treatment in the ED with only 21.6% admitted. Of those discharged, 43.7% sustained contusions, 24.5% had minor open wounds, 12.3% had abrasions, 9% had fractures or dislocations of the upper limb, 4.7% had fractures of the lower limb, and 1.1% had burns. Using the Abbreviated lnjury Scale (AIS) 1990 version, the mean severity score was 1.16 (95% CI 1.15 to 1.17) for the discharged patients. A mean of 4.39 days (95% CI 4.29 to 4.49) of sick leave was given to the discharged patients. After discharge from the ED, 49% did not require review, 22.4% were referred to primary health care doctors, 22.2% were referred to the orthopedic outpatient clinic, and 6.2% to other specialist outpatient clinics. Conclusion: Trauma-related complaints contributed to more than one fifth of the ED workload. Most of these were minor trauma with low AIS score. After treatment in the ED, more than 75% of patients were discharged. Of those discharged, almost half did not require any review. The injuries of this group of patients probably could have been treated successfully by primary health care doctors without requiring ED services.
87 Abdominal Documentation Deficiencies in the Evaluation of Nontraumatic Pain: Effects of a Structured Template
Table, abstract 385.
McMahan SD, BudererNF, KingRW, PlewaMC/St. VincentMercy MedicalCenter,Toledo,OH
Departmental funding sources Collections of professional charges Hospital management contract University support Grants and other contracts
53% 20% 7% 3% Cont'd
S 98
Study objectives: To compare the completeness of documentation of emergency physician records of patients with acute, nontraumatic abdominal pain before and 1 month after instituting the use of a structured template charting system. Methods: A retrospective records review of 165 (before) and 113 (after) patients age older than 5 years with a chief complaint of acute, nontraumatic abdominal pain treated in an urban teaching hospital emergency department. Excluded were patients with chronic or recurrent abdominal pain or evaluation by non-emergency physicians.
ANNALS OF EMERGENCY MEDICINE
34:4 OCTOBER 1999, PART 2