Articles: hospital-emergency-service.
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Background and Objectives: Acute heart failure (AHF) is a life-threatening condition frequently encountered in the emergency department (ED). Identifying reliable prognostic indicators for in-hospital mortality is crucial for risk stratification and the appropriate management of AHF patients. This study aimed to assess the most effective method for predicting in-hospital mortality among various physiological parameters in patients with AHF presenting to the ED. ⋯ A RAM index > 18.6 demonstrated a 7.36-fold higher risk of in-hospital mortality with a sensitivity of 0.80, specificity of 0.68, and negative predictive value of 0.97. Conclusions: The RAM index is an effective tool to predict mortality in AHF patients presenting to the ED. Its superior performance compared to traditional SI-based parameters suggests that the RAM index can aid in risk stratification and the early identification of high-risk patients, facilitating timely and aggressive treatment strategies.
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A short systematic review was undertaken to assess whether adult patients presenting to the ED with a first seizure require a CT head scan to rule out emergent intracranial pathology. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. ⋯ Our results indicate that adults presenting with a first seizure are a high-yield group for CT with a number needed to scan (NNS) between 10 and 19 for findings that would change management in ED, such as haemorrhage, infarction and tumours. We believe that this NNS is sufficiently low to justify the routine use of neuroimaging for these patients in emergency care.
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Multicenter Study Observational Study
Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments.
Older patients living with frailty have an increased risk for adverse events. The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. The aim of this study was to investigate the association between CFS scores and 30-day mortality in an ED setting when assessments are made by regular ED staff. ⋯ Patients living with frailty, had significantly higher mortality and admission rates as well as longer ED and in-hospital LOS compared with robust patients. The results confirm the capability of the CFS to risk stratify short-term mortality in older ED patients.
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Observational Study
Reduced noise in the emergency department: the impact on staff well-being and room acoustics.
The ED is often perceived as noisy. Excessive noise has deleterious effects on health and productivity. This study evaluated if a package of noise-reducing interventions altered workload, physical complaints, productivity and room acoustics. ⋯ The package of behavioural, acoustical and technical interventions was associated with increased staff well-being, reflected by decreased perception of noise, increased productivity, decreased physical complaints and observable changes in behaviour. Furthermore, the interventions positively influenced the room acoustics.
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Junior doctors joining EDs are required to rapidly acquire new knowledge and skills, but there is little research describing how this process can be facilitated. We aimed to understand what would make ED formal induction and early socialisation more effective. ⋯ Effective socialisation, consistent with previous literature, was identified as critical. Junior doctors see consultant behaviours and interactions as key to creating a safe learning space.