International journal of emergency medicine
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In The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multicenter studies have been performed to quantify LOS and assess crowding at Dutch EDs. We performed this study to describe the current state of emergency departments in The Netherlands regarding patients' length of stay and ED nurse managers' experiences of crowding. ⋯ Despite a relatively short LOS, frequent crowding appears to be a nationwide problem according to Dutch ED nurse managers, with 68% of them reporting that crowding occurred several times a week or even daily. Consultations delays, laboratory and radiology delays, and hospital bed shortage for patients needing admission were believed to be the most important factors contributing to ED crowding.
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There is a growing interest in emergency departments (EDs) and the development of emergency medicine in The Netherlands. In the last decade several policy reports have stated that the quality of emergency care should be improved and that emergency physicians (EPs) play a large role in the quality improvement. The Netherlands Society of Emergency Physicians (NVSHA) has developed an emergency medicine training program, which has been nationally recognized since 2009. Nevertheless, not all EDs are staffed with EPs yet. This study aimed to explore differences between Dutch EDs with EPs and those without EPs. ⋯ This study shows that EPs are significantly more present in larger EDs and in EDs where there is more continuing professional education and where there are more clinical audit activities. Our findings suggest that the presence of emergency physicians is positively associated with the quality of emergency care, but prospective research is required to examine causality.
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It is not known whether lack of recognition of organ failure explains the low compliance with the "Surviving Sepsis Campaign" (SSC) guidelines. We evaluated whether compliance was higher in emergency department (ED) sepsis patients with clinically recognizable signs of organ failure compared to patients with only laboratory signs of organ failure. ⋯ The presence of clinically evident compared to biochemical signs of organ failure was associated with increased compliance with a SSC-based resuscitation bundle and admission to the ICU, suggesting that recognition of severe sepsis is an important barrier for successful implementation of quality improvement programs for septic patients. In septic ED patients admitted to the ICU, the time to antibiotics was shorter compared to patients admitted to a normal ward.
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Splenic injury is normally associated with trauma, but spontaneous splenic rupture has been described in various systemic diseases. ⋯ Non-traumatic splenic rupture is a rare complication of oral anticoagulation.
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The incidence of delayed emergency calls and the outcome of out-of-hospital cardiac arrest (OHCA) may differ among public facilities when emergency calls are placed by institutional staff. The purpose of this study was to identify the actions prescribed in the rules and/or manuals of public facilities and to clarify whether the incidence of delayed emergency call placement and the outcome of OHCA differ among these facilities. ⋯ Manuals or rules for making emergency calls in our public facilities may contain incorrect information, and emergency calls may be delayed owing to correctable human factors. Such manuals should be checked and revised.