European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs. ⋯ The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.
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The goal of this study was to compare the prediction performance of two anatomic scales, the Injury Severity Scale (ISS) and the New Injury Severity Scale (NISS), with two physiologic scales, the Revised Trauma Scale (RTS) and the Simplified Acute Physiology Scale II (SAPS II), in trauma patients. ⋯ Both ISS and NISS showed better predictive severity performance compared with RTS and SAPS II in trauma patients. The combination of anatomic scales with physiologic ones did not improve the prediction performance of each scale considered alone.
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We aimed to implement the European Resuscitation Council (ERC) basic life support (BLS) and automated external defibrillator (AED) course as a mandatory peer-led training programme for medical students and to evaluate the satisfaction with this course. Medical students certified as ERC BLS/AED instructors were recruited as student trainers and organizers of the course, which was included as a mandatory part of the curriculum for second-year medical students before first clinical rotation. After each course, questionnaires were distributed to evaluate the peer-led training programme. ⋯ The quality of the course was rated as 9.4±0.8 (10-point scale, 10 being best), and the majority (95%) felt better prepared for their clinical rotation. Implementation of the ERC BLS/AED course as a mandatory peer-led training programme for medical students is feasible. The course has been very well accepted and the students feel better prepared for their first clinical rotation.
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Presentation with acute chest pain is common, but the conventional 12-lead ECG has limitations in the detection of regional myocardial ischaemia. The previously described method of the body surface mapping system (BSM) Delta map, derived from an 80-electrode BSM, as well as a novel parameter total ischaemic burden (IB), may offer improved diagnostic sensitivity and specificity in patients with myocardial ischaemia. ⋯ This pilot study confirms the feasibility of using the Delta map for the diagnosis of ACS in patients presenting to the ED with cardiac-sounding chest pain and suggests that it has promising diagnostic accuracy and has superior sensitivity and specificity to the 12-lead ECG. The novel parameter of IB shows a significant correlation with troponin-I and is a promising tool for describing the extent of ischaemia. The use of the BSM Delta map in the ED setting could improve the diagnosis of clinically important ischaemic heart disease and furthermore presents the result in an intuitive manner, requiring little specialist experience. Further larger scale study is now warranted.