scholarly journals LO09: Assessing the ability of emergency department patients to self-triage by using an electronic questionnaire: a pilot study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S30
Author(s):  
S. Trivedi ◽  
J. Littmann ◽  
P. Kapur ◽  
M. Betz ◽  
J. Stempien
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Prospective Observational Study ◽  
Convenience Sample ◽  
Survey Tool ◽  
Electronic Questionnaire ◽  
Ambulatory Patients ◽  
Chief Complaints ◽  
The Mean ◽  
Emergency Department Patients

Introduction: The process of triage is used to prioritize the care of patients arriving in the emergency department (ED). To our knowledge, self-triage has not been previously studied in the general emergency department (ED) setting. In an attempt to test the feasibility of implementing this in the ED, we sought to assess the ability of ED patients to triage themselves using an electronic questionnaire. Methods: This was a prospective observational study. An iPad-based questionnaire was designed with a series of ‘yes’ or ‘no’ answers related to common chief complaints. A score corresponding to a Canadian Triage and Acuity Scale (CTAS) category was assigned based on their answers, without the knowledge of patients or ED staff. These scores were subsequently compared to the official CTAS score assigned by triage nurses. A convenience sample of ambulatory patients arriving at the ED were enrolled over a four week period. Patients arriving by ambulance were excluded. We also sought to assess patients’ ability to predict their ultimate disposition. Results: A total of 492 patients were enrolled. The mean age of enrolled patients was 43.9. Of enrolled patients, 56 (11.4%) were under 20 years old, 168 (34.1%) between ages 20-39, 116 (23.6%) between ages 40-59 and 152 (30.9%) older than 60 years. We had 245 (49.8%) patients identify as male. Patient-determined CTAS scores were as follows: 146 CTAS 1 (26.7%), 66 CTAS 2 (13.4%), 176 CTAS 3 (35.8%) and 104 CTAS 4 and 5 (21.1%). Formal triage CTAS scores were: 47 CTAS 2 (9.6%), 155 CTAS 3 (31.5%), and 290 CTAS 4 and 5 (59%). With our survey tool, 22.2% of patients matched their official triage scores. We found that that 69.9% of participants over-estimated their CTAS score while 7.9% underestimated it. Two hundred and three patients (41.3%) felt that they needed to be admitted. In fact, 73 patients (17.3%) were admitted to hospital. Conclusion: Using an electronic questionnaire, ambulatory patients frequently overestimated the acuity of their presenting complaint. Patients were also not unable to accurately predict their disposition. Further study of different approaches to self-triage is needed before possible implementation in EDs.

scholarly journals Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0212181 ◽  
Author(s):  
Gideon H. P. Latten ◽  
Lieke Claassen ◽  
Marnix Jonk ◽  
Jochen W. L. Cals ◽  
Jean W. M. Muris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Prospective Pilot Study ◽  
Prehospital Phase ◽  
Emergency Department Patients

scholarly journals Feasibility and Reliability of a Multisource Feedback Tool for Emergency Medicine Residents

2011 ◽  
Vol 3 (3) ◽  
pp. 356-360 ◽  
Author(s):  
Gregory Garra ◽  
Andrew Wackett ◽  
Henry Thode
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Correlation Coefficients ◽  
Multisource Feedback ◽  
Resident Performance ◽  
Self Evaluation ◽  
Evaluation Of Performance ◽  
Interclass Correlation ◽  
The Mean ◽  
Emergency Department Patients

Abstract Background While the Accreditation Council for Graduate Medical Education recommends multisource feedback (MSF) of resident performance, there is no uniformly accepted MSF tool for emergency medicine (EM) trainees, and the process of obtaining MSF in EM residencies is untested. Objective To determine the feasibility of an MSF program and evaluate the intraclass and interclass correlation of a previously reported resident professionalism evaluation, the Humanism Scale (HS). Methods To assess 10 third-year EM residents, we distributed an anonymous 9-item modified HS (EM-HS) to emergency department nursing staff, faculty physicians, and patients. The evaluators rated resident performance on a 1 to 9 scale (needs improvement to outstanding). Residents were asked to complete a self-evaluation of performance, using the same scale. Analysis Generalizability coefficients (Eρ2) were used to assess the reliability within evaluator classes. The mean score for each of the 9 questions provided by each evaluator class was calculated for each resident. Correlation coefficients were used to evaluate correlation between rater classes for each question on the EM-HS. Eρ2 and correlation values greater than 0.70 were deemed acceptable. Results EM-HSs were obtained from 44 nurses and 12 faculty physicians. The residents had an average of 13 evaluations by emergency department patients. Reliability within faculty and nurses was acceptable, with Eρ2 of 0.79 and 0.83, respectively. Interclass reliability was good between faculty and nurses. Conclusions An MSF program for EM residents is feasible. Intraclass reliability was acceptable for faculty and nurses. However, reliable feedback from patients requires a larger number of patient evaluations.

scholarly journals Demographic Analysis of Emergency Department Patients at the Ruijin Hospital, Shanghai

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Wim Lammers ◽  
Willem Folmer ◽  
Esther M. M. Van Lieshout ◽  
Terry Mulligan ◽  
Jan C. Christiaanse ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
General Surgeon ◽  
Demographic Analysis ◽  
Sectional Study ◽  
Specific Population ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Emergency Department Patients ◽  
Insight Into

Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED). The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%), stomach/abdominal pain (15%), vertigo/dizziness (11%), and cough (10%). Following triage, patients were predominantly referred to an internist (41%), neurologist (14%), pulmonologist (11%), or general surgeon (9%). This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.

scholarly journals Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Ralphe Bou Chebl ◽  
Sarah Jamali ◽  
Nancy Mikati ◽  
Reem Al Assaad ◽  
Karim Abdel Daem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Reference Range ◽  
Serum Lactate ◽  
Optimal Cutoff ◽  
The Mean ◽  
Emergency Department Patients ◽  
Lactate Levels ◽  
Youden’S Index

Abstract Objective The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range. Methods This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality. Results During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD. Conclusion The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.

scholarly journals Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study

2017 ◽  
Vol 19 (1) ◽  
pp. e19 ◽  
Author(s):  
Peter R Chai ◽  
Stephanie Carreiro ◽  
Brendan J Innes ◽  
Rochelle K Rosen ◽  
Conall O'Cleirigh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Acute Fracture ◽  
Emergency Department Patients

scholarly journals LO37: Prevalence of cigarette smoking amongst adult emergency department patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S20-S21
Author(s):  
A. Tolmie ◽  
R. Erker ◽  
T. Oyedokun ◽  
E. Sullivan ◽  
T. Graham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cigarette Smoking ◽  
Intervention Program ◽  
Smoking Prevalence ◽  
Health Concern ◽  
Chi Square ◽  
Smoking Cessation Counselling ◽  
Chief Complaints ◽  
Statistics Canada ◽  
Emergency Department Patients

Introduction: Tobacco smoking is a priority public health concern, and a leading cause of death and disability globally. While the smoking prevalence in Canada is approximately 13-18%, the proportion of smokers among emergency department (ED) patients has been found to be significantly higher. This disparity primes the emergency department as a critical environment to provide smoking cessation counselling and support. Methods: A verbal questionnaire was administered to adult patients (18+) presenting to Royal University, Saskatoon City, and St. Paul's Hospital ED's. Patients were excluded if they were underage, too ill, or physically/mentally unable to complete the questionnaire independently. Patients’ smoking habits were also correlated with Fagerstrom tobacco dependence scores, chief complaints, Canadian Triage Acuity Scale (CTAS) scores, and willingness to partake in ED specific cessation counselling. Data were analyzed using IBM SPSS software to determine smoking prevalence and compared to Statistics Canada data using chi-square tests. Results: In total, 1190 eligible patients were approached, and 1078 completed the questionnaire. Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which is significantly higher than the general adult Saskatchewan public at 15.1% (p < 0.0001). Comparing smoking and non-smoking cohorts, there are no significant differences in CTAS scores (p = 0.60). Of the proposed cessation interventions, ED cessation counselling was most popular among patients (62.4%), followed by receiving a pamphlet (56.2%), and being contacted by a smokers’ quit line (49.5%). Out of the smoking cohort, 51.4% indicated they want to quit smoking, and would be willing to partake in ED-specific cessation counselling, if available. Additionally, 88.1% of current smokers started smoking when they were less than 19 years old. Conclusion: The higher smoking prevalence demonstrated in ED patients highlights the need for a targeted intervention program that is feasible for the fast-paced environment. Quit attempts have been demonstrated to be more efficacious with repeated interventions, which could be achieved by training ED staff to conduct brief motivational interviews and faxing referrals to a smokers' quit line for follow-up. Furthermore, pediatric ED's could be a valuable location for cigarette smoking screening, as the majority began smoking in their adolescence.

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