Emergency medicine journal : EMJ
-
Despite 'hospital resilience' gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. ⋯ Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.
-
Ethical issues with regard to resuscitation are increasingly important. Understanding how emergency physicians deal with these problems is essential for the development of policies for resuscitative care. ⋯ Local emergency physicians are as affected by legal and ethical CPR issues as are US emergency physicians. Education programmes and policies that deal with these concerns would better assist the emergency physician in dealing with them.
-
A short cut review was carried out to establish whether a negative D-dimer could be used to rule out pulmonary embolism in the presence of clinical suspicion in a pregnant patient. Five studies were considered directly relevant to the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes and study weaknesses were tabulated. The clinical bottom line was that a negative D-dimer result was considered sensitive enough to rule out pulmonary embolism in patients who were in the first two trimesters of pregnancy but that the false positive rate was so high as to render the test useless in patients in the third trimester if standard cut-off values were used.
-
Multicenter Study
Predictive accuracy of triage nurses evaluation in risk stratification of syncope in the emergency department.
Syncope is a common clinical problem that accounts for 1-3% of all emergency department (ED) visits. Its prognosis is extremely variable with a 1-year mortality that may reach 30%. There are no available data about the accuracy of nursing triage in identifying high-risk syncope. The aim of our study was to evaluate the predictive accuracy of nursing triage in identifying high-risk syncope. ⋯ Nursing triage was characterised by a low predictive accuracy in identifying high-risk individuals.