scholarly journals P009: Emergency department overcrowding associated with increased door-to-ecg time in patients with chest pain

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S60-S60
Author(s):  
M. Bhatia ◽  
W. Hopman ◽  
C. Mckaigney ◽  
D. Loricchio ◽  
A. K. Hall
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Tertiary Care ◽  
Positive Association ◽  
Additional Patient ◽  
Negative Consequences ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Ed Overcrowding ◽  
Age And Sex

Introduction: Emergency Department (ED) overcrowding has been shown to delay time sensitive tests and therapies. North American guidelines call for Door-to ECG (DTE) times to be <10min in patients presenting with chest pain as delays have been shown to lead to poorer patient outcomes. We hypothesize that increased ED crowding will increase the DTE times. Methods: This was a retrospective cohort study from July 2015-May 2016 at a single tertiary care Canadian ED (53000 visits per year). Data were extracted from the ED information system (EDIS) which contains an organized record of ED activity for each visit. Our selection criteria screened for patients presenting with complaints that included chest pain, chest heaviness, chest tightness and chest burning. The primary outcome of the study was the association between ED occupancy and DTE time, which was measured using a non-parametric Spearman correlation. Multivariable linear regression models controlling for age and sex were developed for both time in minutes, and the log transformed time in minutes. Results: There were 2479 ECGs done on patients presenting with chest pain that met inclusion criteria. The median DTE time was 55.1 minutes. There was a significant positive association between DTE time and ED occupancy (rho=.133, p<0.001). DTE time increased by 0.64 minutes (or approximately 0.4%) for each additional patient in the ED, p<0.001. Additionally, younger age and female sex were also associated with increased DTE time. Conclusion: Increased ED occupancy was correlated with longer DTE times at a single Canadian ED, even after controlling for age and sex. This study provides an example of the negative consequences of ED overcrowding.

Abstract 115: Predictors Of A Positive Stress Test Among Patient Presenting To The Emergency Department With Chest Pain

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Taraka V Gadiraju ◽  
Jahnavi Sagi ◽  
Dev Basu ◽  
Srikanth Penumetsa ◽  
Michael Rothberg
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Stress Test ◽  
Tertiary Care ◽  
Face Validity ◽  
Pseudorandom Number Generator ◽  
Multivariable Model ◽  
Final Multivariable Model ◽  
Significant Difference ◽  
History Of

Objectives: Patients frequently present to the hospital with chest pain. Once myocardial infarction is ruled out based on EKG and cardiac enzymes, most patients undergo stress testing, but only few patients have a positive test. In ambulatory practice, age, sex and symptomatology can establish pretest probability of the coronary disease. However, there are no studies evaluating the predictors of a positive stress test in the emergency department (ED). We assessed predictors for a positive stress test in patients presenting to our hospital with chest pain. Methods: This is a case-control study conducted on a subset of patients admitted to our tertiary care center with chest pain between 2007 and 2009, and who had an inpatient stress test (n=1474). Using chart review, we identified 87 patients, whose stress tests were positive (abnormals), defined as presence of ischemia on EKG and/or imaging modalities. We then used a pseudorandom number generator to select 194 patients whose stress test results were normal (normals) for comparison. Clinical features of chest pain and CAD risk factors were abstracted from the medical record for comparison. A bivariable screening process was used to identify characteristics for inclusion in a multivariable predictive model. Sex and age were maintained in the model for face validity, and remaining covariates were removed in ascending order of their z-statistics until only those with a two-sided p-value of <0.10 remained. Stata 12.1 (Copyright 2011, StataCorp LP) was used for all analyses. Results: Patients with an abnormal stress test were older and more likely to be male and to have a history of vascular disease. Although patients with abnormal stress test were more likely to have history of hypertension, hyperlipidemia and current or ex-smoking, this difference was not statistically significant. Over half of the patients presented with non-cardiac chest pain and there was no significant difference in the chest pain characteristics between patients who had a normal and an abnormal stress test result. In the final multivariable model, when compared to the normals, abnormals were four times as likely to have a history of revascularization (OR 4.13, 95% CI 2.11, 8.09) and twice as likely to have a history of hyperlipidemia (OR 2.1, 95% CI 1.18, 3.79). They were also more likely to have an EKG suggestive of ischemia at presentation (OR 1.90, 95% CI 1.03, 3.53). Specificity of the model was 89%; sensitivity was 43%, and the c-statistic for the final multivariable model was 0.76, suggesting fair to good discrimination. Conclusions: Among patients presenting to the ED with chest pain, a past history of revascularization and hyperlipidemia and an EKG suggestive of ischemia may independently predict the likelihood of an abnormal stress test. Further validation of this model on an external dataset is necessary.

scholarly journals Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

CJEM ◽  
2006 ◽  
Vol 8 (03) ◽  
pp. 164-169 ◽  
Author(s):  
Robert Steele ◽  
Timothy McNaughton ◽  
Melissa McConahy ◽  
John Lam
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Diagnostic Test ◽  
Tertiary Care ◽  
Positive Likelihood Ratio ◽  
Care Hospital ◽  
Artery Disease

ABSTRACT Introduction: It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin. Objective: To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain. Design: Prospective observational cohort study with a 4-week follow-up of patients enrolled. Setting: Academic tertiary care hospital, with 60 000 visits/year. Inclusion criteria: Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain. Exclusion criteria: Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization. Results: 270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%–80%), and the specificity was 37% (34%–41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96–1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate. Conclusions: Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain.

scholarly journals P130: Cumulative daily boarding time: a new way to measure emergency department congestion and hospital-wide flow

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S103-S103
Author(s):  
L. Salehi ◽  
V. Jegatheeswaran ◽  
P. Phalpher ◽  
R. Valani ◽  
M. Mercuri
Keyword(s):  
Emergency Department ◽  
Negative Impact ◽  
Linear Regression Analysis ◽  
Positive Association ◽  
High Volume ◽  
Initial Assessment ◽  
Process Time ◽  
Alternative Measure ◽  
Ed Overcrowding ◽  
Number Percentage

Introduction: Bed boarding of admitted patients in the Emergency Department (ED) is one of the major contributors to ED overcrowding, and an indicator of hospital-wide deficiencies in capacity and flow. Most indicators of ED overcrowding have measured either counts or percentages of patient subgroups (e.g. number/percentage of patients waiting in triage or number/percentage of admitted patients as compared to full ED census), or specific process time intervals related to patient movement through the hospital (e.g. Physician to Initial Assessment (PIA) time or total ED Length of Stay (EDLOS)). We sought to 1) devise an alternative measure of ED overcrowding that captured the dynamic and disproportionate resource utilization of admitted versus non-admitted patients in the ED, and to 2) determine the association of this measure with selected ED quality metrics for non-admitted patients. Methods: We conducted a retrospective multi-centre observational study at three very high-volume community hospitals in the Greater Toronto Area. Data on all patients visiting the ED during the period between January 1, 2015 and December 31, 2016 were included in the study. We calculated the total daily cumulative boarding time - or time to bed (TTB) - for each day of the study duration. The daily cumulative TTB was calculated as the time from decision to admit to transfer from the ED for all admitted patients within a 24-hour period. We conducted linear regression analysis to determine the association between our measured daily cumulative TTB and daily median and 90th percentile PIA and EDLOS times for non-admitted patients. Results: Preliminary results for 2015 indicate a total cumulative TTB time ranging from 50,973 hours to 191,093 patient-hours for the year, with daily mean cumulative TTB ranging from 140 524 patient-hours/day among the three hospitals. In all three hospitals, there was a statistically significant (p<0.01) positive association between daily cumulative TTB and both median and 90th percentile PIA times for all patients, and median EDLOS times for non-admitted CTAS 1 -3 patients. There was a statistically significant (p<0.05) positive association between daily cumulative TTB and 90th percentile EDLOS for non-admitted CTAS 1-3 patients in two of the three hospitals, with the third hospital showing a positive but non-significant association. Conclusion: Bed boarding constitutes a significant resource cost for EDs, and has a negative impact on timeliness of ED care for the general ED population, particularly more complex (CTAS 1-3) non-admitted patients.

Perceived discrimination, loneliness, and non-suicidal self-injury in Chinese migrant children: The moderating roles of parent-child cohesion and gender

2020 ◽  
pp. 026540752097475
Author(s):  
Quanquan Wang ◽  
Ye Zhang ◽  
Xia Liu
Keyword(s):  
Perceived Discrimination ◽  
Positive Association ◽  
Migrant Children ◽  
Mediating Effect ◽  
Negative Consequences ◽  
Significant Positive Association ◽  
Self Injury ◽  
And Gender ◽  
The Relationship ◽  
Parent Child

Chinese rural-to-urban migrant children frequently experience discrimination, which thereby often results in significant negative consequences. However, little is known about the contribution of perceived discrimination experiences to non-suicidal self-injury (NSSI). This study aimed to examine the relationship between perceived discrimination and NSSI, the mediating role of loneliness in this relationship, and the moderating roles of parent-child cohesion and gender. Six hundred fifty-seven migrant children completed a perceived discrimination scale, an NSSI questionnaire, a loneliness scale, and a parent-child cohesion inventory. Results showed that there was a significant positive association between perceived discrimination and NSSI among migrant children. Loneliness mediated the relationship between perceived discrimination and NSSI. Moreover, parent-child cohesion demonstrated a moderating effect on the mediation via loneliness; the indirect association between perceived discrimination and NSSI via loneliness was only significant in low parent-child cohesion condition, but not in the high condition. Additionally, there were differences by gender, with a significantly stronger mediating effect of loneliness among migrant girls compared with migrant boys. The findings from this study contribute to the understanding of the underlying mechanisms in the relationship between perceived discrimination and NSSI. Discussion also provides directions for future interventions and delineate how programs could be designed to target loneliness and parent-child cohesion among migrant children.

scholarly journals Trends in use in a Canadian pediatric emergency department

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 405-410 ◽  
Author(s):  
Quynh Doan ◽  
Emerson D. Genuis ◽  
Alvis Yu
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Ed Overcrowding ◽  
Secondary Outcomes ◽  
Ed Crowding

ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

scholarly journals Correlation of Fasting and Post Prandial Plasma Glucose with Hemoglobin Glycation

2013 ◽  
Vol 4 (2) ◽  
pp. 28-30 ◽  
Author(s):  
Muhammad Saiedullah ◽  
Shoma Hayat ◽  
Syed Muhammad Kamaluddin ◽  
Shahnaj Begum
Keyword(s):  
Linear Regression ◽  
Plasma Glucose ◽  
High Performance ◽  
Linear Regression Analysis ◽  
Positive Association ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Medical College ◽  
Relative Contribution ◽  
Hemoglobin Glycation

Association of fasting plasma glucose (FPG) and post prandial plasma glucose (PPG) on hemoglobin glycation is still controversial. In this study we aimed to assess the influence of FPG and PPG on hemoglobin glycation in newly diagnosed never treated diabetic (NDNT-DM) subjects and treated diabetic (T-DM) subjects. One hundred and seventy seven diabetic subjects were included in this study. Plasma glucose concentrations were measured by hexokinase end point technique and glycated hemoglobin (HbA1c) levels were measured by modified cationexchange high performance liquid chromatography (HPLC). Univariate and multivariate linear regression models were applied to assess the relative contribution of FPG and PPG on HbA1c. Univariate linear regression analysis showed significant positive association of FPG and PPG with HbA1c in both groups. Multivariate regression model showed that ? (beta) value of HbA1c was 0.5528 (p<0.0001) for FPG and 0.3047 (p<0.01) for PPG in the NDNT-DM whereas 0.5509 (p<0.0001) for FPG and 0.1874 (p>0.05) for PPG in treated diabetic subjects. After adjustment for age and sex, beta remains statistically significant for FPG and PPG where beta value for FPG was higher for FPG than for PPG in both NDNT-TM group and T-DM groups. This study revealed that FPG has a stronger association on hemoglobin glycation as compared to PPG in diabetes mellitus. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 28-30 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16939

scholarly journals An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Yuwares Sittichanbuncha ◽  
Patchaya Sanpha-asa ◽  
Theerayut Thongkrau ◽  
Chaiyapon Keeratikasikorn ◽  
Noppadol Aekphachaisawat ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Tertiary Care ◽  
Previous History ◽  
Final Diagnosis ◽  
Care Hospital ◽  
Online Tool ◽  
Coronary Syndrome ◽  
Nurse Triage

Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital.Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed.Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively.Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

scholarly journals Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

CJEM ◽  
2015 ◽  
Vol 18 (3) ◽  
pp. 191-204 ◽  
Author(s):  
Ivy Cheng ◽  
Maaret Castren ◽  
Alex Kiss ◽  
Merrick Zwarenstein ◽  
Mats Brommels ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Tertiary Care ◽  
Cost Benefit ◽  
Cost Effective ◽  
Additional Patient ◽  
Patient Volume ◽  
Benefit Ratio ◽  
Cost Benefit Ratio ◽  
The Cost

ABSTRACTObjectiveThe purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.MethodsThis was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario’s Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.ResultsThe added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of –$447,996 [–$435,646 to –$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.ConclusionsThe MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.

scholarly journals Evaluation of Routine Coagulation Parameter in Suspected Acute Myocardial Infarction Patients Attending Emergency Department of Tertiary Care Hospital

2021 ◽  
Author(s):  
Mritunjay Kumar Mishra ◽  
DVSS Ramavataram ◽  
Tejas Shah
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Fatty Material ◽  
Care Hospital ◽  
Medical Terminology ◽  
Positive Correlation

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p<0.0001). Pearson correlation analysis in AMI patients, a slightly positive correlation between BMI and aPTT was observed (r=0.19, p<0.001) and also between PT and aPTT (r=0.66, p<0.001). Conclusion: There was a slightly positive correlation found between BMI and aPTT which indicated that the weight and height of the patients do not affect the plasma PT and aPTT levels on anticoagulant therapy.

scholarly journals Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

2020 ◽  
Vol 36 (5) ◽  
Author(s):  
Faryal Akbar Jalbani ◽  
Shiraz Shaikh ◽  
Subhani Fatima
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Public Sector ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Positive Association ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Significant Positive Association ◽  
Cross Sectional

Objective: To determine the time from onset of symptoms to start of fibrinolysis and treatment in acute ST elevated myocardial infarction patients and identify the factors which cause delay in treatment. Methods: A cross sectional study was conducted at National Institute of Cardiovascular Diseases, Karachi on 360 conveniently selected patients of ST elevated myocardial infarction from July to September in the year 2017. Structured questionnaire was used to obtain detailed information on socio-demographics, factors which cause delay and timing of onset of symptoms to arrival of patient in emergency ward. Results: Overall, the total average time from the start of symptoms to initiation of treatment was 119.85±63.32 minutes. Only 5.1% patient reached within one hour while 57.7% reached within two hours. Old age group of 60 and above was positively associated with timely arrival (OR=2.75, 95% CI 1.33-5.68, p=0.006). Significant positive association of using personal car as mode of transport to reach the hospital (OR=5.25, 95% CI 2.94-9.35, p<0.001) was also found as compared to using ambulance. Distance from facility was suggestive of negative association in the model but was statistically insignificant. Conclusion: According to the findings of this study, more than one third of patients reached the hospital within two hours of initiation of symptoms while only 5.1% reached within one hour. The delay was mostly pre-hospital attributed to arranging transport, stay at first medical contact and time taken from first medical contact to the hospital. doi: https://doi.org/10.12669/pjms.36.5.2104 How to cite this:Jalbani FA, Shaikh S, Fatima S. Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi. Pak J Med Sci. 2020;36(5):---------.  doi: https://doi.org/10.12669/pjms.36.5.2104 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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