PubMed · 16619789
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Stephen Elgert. 2006-03-17. A simple change.. https://pubmed.ncbi.nlm.nih.gov/16619789/
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Identification of the meticillin-resistant Staphylococcus aureus (MRSA) reservoir by active screening followed by the implementation of contact precautions is one of the major components of MRSA control programmes. The objective of this study was to evaluate the results of a programme of selective screening in an emergency department (ED) and the appropriateness of the contact precautions implemented. This was estimated by distinguishing necessary and unnecessary days of contact precautions. This estimation was performed for all days of contact precautions and, more specifically, for days of preventive contact precautions implemented before the availability of screening results. During a three-year period, screening of MRSA carriers was performed on 0.95% (N=605) of patients visiting the emergency ward. Among the 193 (31.9%) MRSA carriers identified, 159 were hospitalized in the short-length-hospitalization area (SLHA) of the ED and/or in other wards. Among the 140 patients admitted to the SLHA, 44 were hospitalized for at least 48 h, with a mean length of hospitalization of 5.9 days. The cumulative duration of hospitalization of carriers identified by screening was 1897 days. In total, 2370 days of contact precautions (including 924 days of preventive precautions) were implemented for patients screened in the ED. Considering the whole hospital, the appropriateness of this entire programme of contact precautions for patients screened in the ED was 80.0% (52.1% for the SLHA), whereas the specific appropriateness of preventive isolation days was 48.6% (43.6% for the SLHA). This study underscores the risk of MRSA cross-transmission in the SLHA, and the usefulness of implementing a control programme of screening carriers in the ED.
BACKGROUND AND OBJECTIVE: To determine the effect that the lack of inhospital beds exerts on emergency department performance. MATERIAL AND METHOD: Two different time periods with comparable daily census, but significantly different bed availability. Variables assessed were general emergency department performance markers, emergency department effectiveness markers and objective and subjective quality markers. RESULTS: All variables got worse within lower bed availability period, and reached a change magnitude between 0% and 300% when compared with control period. However, a statistical difference was only achieved in emergency department occupation rate (+14%; p < 0.001), rate of patients waiting to be admitted (+100%; p < 0.001), patients waiting to be seen (+60%; p < 0.01), waiting time to be seen (+83%; p < 0.001), time to employed for first medical assessment and treatment (+44%; p < 0.01), and patients left without being seen (+90%; p < 0.05). CONCLUSIONS: The lack of inhospital beds for patients admitted from the emergency department leads to a remarkable worsening in its function and performance.
Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.