European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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As one of Europe's most densely populated countries with multiple nuclear installations and a prominent petrochemical industry, Belgium is at some reasonable risk for terrorist attacks or accidental chemical, biological, radiation, and nuclear (CBRN) incidents. We hypothesize that local hospitals are not sufficiently prepared to deal with these incidents. ⋯ There are serious gaps in hospital preparedness for CBRN incidents in Belgium. Lack of financial resources is a major obstacle in achieving sufficient preparedness.
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Care providers need accurate information to help them effectively manage patient flow in emergency departments (EDs) and deliver high-quality care within time constraints. Data should alert care providers to clinical risk and poor patient experience. In England, NHS A&E guidance proposes, among others, three measures to understand the distribution of waiting times in EDs - the median wait, 95th percentile and maximum wait. This study explores how well these three measures monitor performance and the potential added value of scatterplots. ⋯ The use of scatterplots could help care providers better understand the distribution of waiting times in EDs, identify where EDs struggle to deliver care against time constraints and highlight poor patient experience and prompt action to address concerns.
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Comparative Study
Identification of adult septic patients in the prehospital setting: a comparison of two screening tools and clinical judgment.
Timely identification and treatment of sepsis is crucial for patient outcome. The aim of this study was to compare two previously unvalidated prehospital sepsis screening tools with clinical judgment by emergency medical services (EMS) personnel with respect to identification of septic patients. ⋯ The Robson screening tool had a sensitivity superior to both BAS 90-30-90 and clinical judgment. This supports our hypothesis that the implementation of a screening tool could lead to increased prehospital identification of sepsis, which may enable a more timely treatment of these patients.
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Observational Study
What is the 30-day rate of adverse cardiac events in chest pain patients with ED troponin I assays≤99th centile using a contemporary sensitive assay? An exploratory analysis.
For nonhigh-risk patients who 'rule out' for acute coronary syndrome, Australasian guidelines recommend further testing to identify coronary artery disease. Testing is usually performed as an outpatient procedure. This recommendation has not changed with the advent of sensitive biomarker assays. We aimed to determine the 30-day rate of adverse cardiac events in emergency department (ED) chest pain patients without known coronary artery disease who had ED troponin I (TnI) assays≤99th centile using a contemporary troponin assay, stratified by the Heart Foundation (HF; Australia) risk group. ⋯ Among ED patients presenting with suspected acute coronary syndrome, adverse cardiac events at 30 days are rare in nonhigh-risk patients with contemporary TnI assays<99th centile.
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The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay. ⋯ SOFA score is a feasible and accurate tool for an early risk stratification of septic patients admitted to the ED-HDU.