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Analysis of factors that determine hospitalization of emergency department patients

100%
Szwamel K., Kurpas D.
Family Medicine & Primary Care Review
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2016
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issue 3
352-358
2
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Predictors of hospitalization in patients presenting to emergency department with an acute exacerbation of COPD – a single-center study in Turkey

100%
Sanalp Menekşe T., Taha Sert E.
European Journal of Clinical and Experimental Medicine
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2023
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issue 3
561-566
EN
Introduction and aim. In this study, we evaluated parameters that might be associated with hospitalization in patients admitted to the emergency department (ED) with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Material and methods. Patients with COPD who presented to ED due to AECOPD between January 1, 2020 and December 31, 2021 were included in the study. Patient data were obtained from the hospital database. Univariable and multivariable logistic regression methods were used to identify the relationship between hospitalization and clinical parameters. Results. The study included 237 patients divided into two groups: inpatients (n=124) and outpatients (n=113). We found significant differences between the two groups in terms of temperature, oxygen saturation, respiratory rate, C-reactive protein, white blood cell count, procalcitonin, albumin, arterial blood pH, pCO2, and non-invasive mechanical ventilation (NIMV) requirement. Multivariable logistic regression analysis showed that body temperature [odds ratio (OR):1.62;95% confidence interval (CI):1.21–4.91; p<0.001], oxygen saturation (OR:0.73, 95% CI:0.39-0.94, p<0.001), respiratory rate (OR:1.96; 95% CI: 1.07–6.14; p<0.001), albumin (OR:0.71; 95% CI:0.41–0.93; p=0.042), procalcitonin (OR:2.93; 95% CI:1.22–4.84; p<0.001), arterial blood pH (OR:0.78; 95% CI:0.29-0.91; p=0.038), pCO2 (OR:2.45; 95% CI:1.24–4.65; p<0.001), and NIMV requirement (OR:2.31; 95% CI:1.41–5.13; p<0.001) were the independent predictors of hospitalization. Conclusion. Our findings may help identify patients who will require hospitalization at an early stage.
3
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The relationship of biochemical parameters and radiological parameters in the evaluation of the clinical severity of acute pancreatitis in the emergency department – a retrospective analysis

88%
Tortum F., Tekin E., Aydın F., Özdal E., Tatlısu K.
European Journal of Clinical and Experimental Medicine
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2023
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issue 2
277-282
EN
Introduction and aim. Computed tomography severity index (CTSI) and Balthazar score are among the most frequently used scorings in the determination of severe acute pancreatitis. The primary purpose of this study is evaluation of the effects of biochemical parameters, Balthazar score and CTSI on mortality in acute pancreatitis. At the same time, correlations with biochemical parameters, CTSI and Balthazar score were evaluated in patients with AP. Material and methods. In this study, the amylase, lipase, CRP, and procalcitonin values of patients diagnosed with acute pancreatitis were retrospectively recorded. Contrast-enhanced computed tomography (CECT) images obtained at the time of presentation to the emergency department or within seven days of admission were re-evaluated by two radiologists. The CTSI scores and Balthazar scores of the patients were calculated. Results. The study included 240 patients. The amylase level of the patients was positively correlated with the Balthazar score at a statistically significant level (R=0.189, p=0.003). In addition, the relationship between pancreatic scoring systems and mortality, the AUC value for CTSI was 0.9 (95% CI: 0.826-0.973) and was higher than other scoring systems. Conclusion. CTSI had better performance in the prediction of mortality in patients with acute pancreatitis.
4
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Fall risk and frailty level in older adults admitted to the emergency department with a complaint of falling

88%
Çelik S., Uğur N., Karahan E., Dolu İ.
European Journal of Clinical and Experimental Medicine
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2023
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issue 4
793-801
EN
Introduction and aim. Falls are the second leading cause of unintentional death in the world. The study was conducted to examine the risk of falls and levels of frailty in older adult patients admitted to the emergency department due to fractures, as well as to identify the factors that influence fall risk and frailty levels. Material and methods. This cross-sectional and correlational study conducted with 155 older patients. Data collected by the patient information form, Itaki Fall Risk Scale and Edmonton Frail Scale. Results. Patients diagnosed with fracture in the emergency department had a high risk of falling with a mean score of 9.55±3.84.70.3% of the patients were frail. The one-third (30.3%) had severe frailty. There was a moderate positive correlation between the risk of falling and the mean frailty score of the older adult patients (p<0.001). Conclusion. The study showed that older adults admitted to the emergency department due to falls are at high risk of falling and the majority of them are frail. Early determination of fall risk and frailty levels in the older adults with a history of falling, prevention of falls and fractures due to falls will be beneficial in increasing the quality of life of the older adults
5
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Case-crossover design: Air pollution and health outcomes

63%
Szyszkowicz M., Tremblay N.
International Journal of Occupational Medicine and Environmental Health
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2011
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vol. 24
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issue 3
249-255
EN
Objectives: The objective of this study was to investigate variants of case-crossover design for assessing correlations between counts of health events over time and exposure to ambient air pollution. For illustrative purposes, daily emergency department (ED) visits for depression among females were considered. Materials and Method: Ambient nitrogen dioxide (NO₂) was used as a principal ambient air pollutant. In addition, sulphur dioxide (SO₂) and carbon monoxide (CO) were considered. Different configurations of the control periods (every 1, 2, …, 10 days) and different forms (linear, natural splines) of meteorological factors in the applied conditional logistic regression models were used. The sequence of overlapping age intervals was defined ([0, 19], [1, 20], and so on) and each age group was analyzed separately. The results for the defined age sequences allow identifying age ranges in which the effects are strongest. Results: Consequently, for example, different age ranges for patients for which ED visits for depression were correlated with NO₂ and SO₂ were identified. This age-interval difference explains the very often observed phenomenon whereby two air pollutants used in one model may not show correlations with health outcomes. In this situation they affect separate age groups. The results also show dependency on number-defined control periods for the applied case-crossover technique. The opposite statistical conclusions may be generated by using different control schemas. Conclusions: The results support the hypothesis that ED visits for depressive disorder may be correlated with exposure to ambient air pollution.
6
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Zarządzanie czasem w systemie opieki zdrowotnej – wybrane aspekty

51%
Kobza J., Syrkiewicz-Świtała M.
Medycyna Pracy
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2014
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vol. 65
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issue 4
555-566
EN
Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary. Med Pr 2014;65(4):555–566
PL
Zarządzanie czasem (time based management – TBM) stanowi jeden z bardziej istotnych elementów całego procesu zarządzania. Od wielu lat w systemach opieki zdrowotnej krajów wysokorozwiniętych poszukuje się nowych, skutecznych metod zarządzania czasem. Celem pracy jest dostarczenie wiedzy dotyczącej prowadzonych badań i doświadczeń w zakresie wybranych metod i technik zarządzania czasem w sektorze podstawowej opieki zdrowotnej (POZ) i w szpitalach (bloki operacyjne, izby przyjęć), publikowanych w piśmiennictwie międzynarodowym. Artykuł powstał w wyniku przeglądu literatury krajowej od 1990 r. oraz recenzowanych doniesień naukowych piśmiennictwa międzynarodowego w oparciu o PubMed/Medline z okresu 2001–2011. Wyniki badań międzynarodowych wskazują, że ze względu na strukturę demograficzno-zdrowotną społeczeństw lekarze POZ stają przed nowymi wyzwaniami. Wymagania w zakresie dobrego zarządzania czasem i stosowania efektywnych narzędzi (takich jak umiejętność definiowania spraw priorytetowych, planowanie, delegowanie zadań, właściwa koordynacja działań, tworzenie zespołów POZ oraz zwiększenie liczby personelu pomocniczego) są kluczowe. Konieczne będą także zmiana systemu refundacji świadczeń oraz rozwój elektronicznej wymiany informacji, sposobów gromadzenia i przetwarzania wyników badań. Innowacje w technikach informatycznych stosowanych w medycynie (np. wykorzystanie telemedycyny do monitorowania oraz leczenia pacjenta na odległość) dają szansę skrócenia czasu oczekiwania na diagnozę i leczenie, co znajduje zastosowanie w konsultacjach specjalistycznych. W celu podniesienia efektywności zarządzania czasem w szpitalach wdraża się wiele sposobów optymalizacji wykorzystania pracy bloku operacyjnego jak np. wprowadzenie funkcji koordynatora, wprowadzenie standardów postępowania w procesie decyzyjnym, robotyzacja. Przyspieszenie przepływu pacjentów z izby przyjęć na oddziały stanowi klucz do usprawnienia pracy izby. Należy podjąć działania edukacyjne wśród lekarzy i kadry menedżerskiej w Polsce oraz wdrażać rozwiązania stosowane w systemach opieki zdrowotnej krajów wysokorozwiniętych. Med. Pr. 2014;65(4):555–566
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