An emergency department ( ED ), also known as accident & amp; emergency room ( A & amp; E ), emergency room ( ER ), emergency room ( EW ) or victim department , is a medical treatment facility specializing in emergency medicine, acute care of patients present without prior agreement; either in their own way or by ambulance. The emergency department is usually found in hospitals or other primary care centers.
Due to the unplanned nature of the patient's presence, the department should provide early treatment for a wide spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, the emergency department has become an important entry point for those who do not have access to medical care.
Emergency departments in most hospitals operate 24 hours a day, although staff levels may vary in an attempt to reflect the patient's volume.
Video Emergency department
History
Accident services were provided by workers, railway and municipal compensation plans in the late middle of the nineteenth century, but the world's first specialized trauma care center opened in 1911 in the United States at the University. Louisville Hospital in Louisville, Kentucky, and developed by surgeon Arnold Griswold during the 1930s. Griswold also features police and fire trucks with medical supplies and trained personnel to provide emergency care on the way to the hospital.
Currently, a typical hospital has an emergency department in its own section on the ground floor, with a special entrance. Because patients can be present at any time and with any complaint, an important part of the emergency department's operations is to prioritize cases based on clinical needs. This process is called triage.
Triage is usually the first step passed by the patient, and consists of a brief assessment, including a series of vital signs, and the assignment of a "major complaint" (eg chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have special areas for this process, and may have dedicated staff to do nothing but the triage role. In most departments, this role is met by triage nurses, although depending on the level of training in countries and regions, other health care professionals can perform triage sorting, including paramedics or doctors. Triage is usually done face-to-face when the patient presents, or triage form can be done via radio with ambulance crew; in this method, the paramedics will call the hospital triage center with a brief update on the incoming patient, which will then be prioritized to the appropriate level of care.
Most patients will initially be assessed in triage and then forwarded to other areas of the department, or other areas of the hospital, with their waiting times determined by their clinical needs. However, some patients may complete their treatment in the triage phase, for example if the condition is very mild and can be treated quickly, if only advice is required, or if the emergency department is not a suitable treatment point for the patient. Conversely, patients with very serious conditions, such as heart attacks, will bypass the triage altogether and move directly to the appropriate part of the department.
Resuscitation areas, commonly referred to as "Trauma" or "Resus", are key areas in most departments. The sickest or most severely injured patients will be treated in this area, as they contain the tools and staff needed to deal with life-threatening illnesses and injuries. Typical resuscitation staff involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training. These personnel may be assigned to the resuscitation area for an overall shift, or perhaps an "on call" for resuscitation coverage (eg, if a critical case comes through a triage or ambulance run, the team will be faced into the resuscitation area to deal with the case immediately). Resuscitation cases can also be attended by residents, radiographers, ambulance personnel, respiratory therapists, hospital pharmacists and/or students of one of these professions depending on the mix of skills required for each particular case and whether the hospital provides teaching services.
Patients who show signs of severe illness but are not in immediate danger of life or limbs will be prioritized for "acute care" or "department", where they will be seen by a doctor and receive more comprehensive assessment and treatment. Examples of "majors" include chest pain, difficulty in breathing, abdominal pain, and neurological complaints. Advanced diagnostic tests may be performed at this stage, including laboratory testing of blood and/or urine scan, ultrasound, CT or MRI. The right medicine for managing the patient's condition will also be given. Depending on the underlying cause of the patient's primary complaint, he may be discharged from this area or hospitalized for further treatment.
Patients whose conditions are not immediately life-threatening will be sent to a suitable area to deal with, and this area can usually be termed a fast-acting or minors area. Such patients may still be found to have significant problems, including fractures, dislocations, and lacerations that require suturing.
Children can present special challenges in treatment. Several departments have dedicated pediatrics, and some departments use play therapists whose job it is to make children feel comfortable to reduce the anxiety caused by visiting the emergency department, as well as providing interference therapy for simple procedures.
Many hospitals have separate areas for the evaluation of psychiatric problems. These are often administered by psychiatrists and mental health nurses and social workers. Usually there is at least one room for people who are actively at risk for themselves or others (eg suicide).
Rapid decisions about death and death cases are important in the hospital's emergency department. As a result, doctors face enormous pressure to overtake and overtreat. The fear of losing something often leads to additional blood tests and imaging scans for what might be a harmless chest pain, run-of-the-mill head bulges, and non-threatening abdominal pain, at a high cost to the health care system.
Maps Emergency department
Nomenclature in English
Emergency Department is becoming commonplace when emergency medicine is recognized as a medical specialty, and hospitals and medical centers develop emergency medicine departments to provide services. Other common variations include 'emergency ward', 'emergency center' or 'emergency unit'.
'Accident and Emergency' or 'A & amp; E 'is still a term accepted in Britain, Commonwealth countries and the Republic of Ireland, as well as previous terms such as' Victim' or 'victim's home', which continues to be used informally. The same goes for the 'emergency room' or 'ER' in North America, originating when emergency facilities are provided in a hospital room by the surgical department.
Signage
Apart from naming conventions, there is wide use of directions in white text on red backgrounds around the world, indicating the location of the emergency department, or the hospital with the facility.
Signs in the emergency department may contain additional information. In some American states there are strict rules about the design and content of such signs. For example, California requires words like "Comprehensive Emergency Medical Services" and "Doctor Duty", to prevent people who need critical care from presentation to incomplete facilities and staff.
In some countries, including the United States and Canada, smaller facilities that can provide relief in medical emergencies are known as clinics. Larger communities often have walk-in clinics where people with medical problems will not be taken seriously enough to warrant emergency department visits. These clinics often do not operate on a 24-hour basis. A very large clinic can operate as a "stand-alone emergency center," which is open 24 hours and can manage a large number of conditions. However, if a patient comes to a free-standing clinic under conditions requiring hospitalization, he/she should be transferred to the actual hospital, as this facility does not have the ability to provide inpatient care.
United States
The Medicare and Medicaid Service Center (CMS) classifies the emergency department into two types: Type A, the majority, open 24 hours a day, 7 days a week, 365 days a year; and those who are not, Type B. Many of the US emergency departments are very busy. A study found that in 2009, there were an estimated 128,885,040 ED meetings in US hospitals. About one-fifth of ED visits in 2010 are for patients under 18 years of age. In 2009-2010, a total of 19.6 million emergency department visits in the United States were conducted by people 65 years and older. Most meetings (82.8 percent) resulted in care and release; 17.2 percent were admitted to the inpatient ward.
Medical Emergency Treatment 1986 and the Active Employment Act are the actions of the United States Congress, requiring the Emergency Department, if the relevant hospitals receive payments from Medicare, to provide appropriate medical examinations and emergency care for all individuals seeking medical treatment, regardless of medical condition citizenship, legal status, or ability to pay. Like an unfunded mandate, there is no provision for replacement.
The rate of ED visits increased between 2006 and 2011 for almost every patient's characteristic and location. The total ED visit rate increased 4.5% at the time. However, the visitation rate for patients under one year of age decreased 8.3%.
A survey of doctors in New York in February 2007 found that injury and even death were caused by too many hospital beds waiting by Emergency patients. A 2005 patient survey found an average ED waiting time of 2.3 hours in Iowa up to 5.0 hours in Arizona.
One Los Angeles area hospital examination by congressional staff found ED to operate an average of 116% of capacity (meaning there were more patients than available treatment rooms) with insufficient beds to accommodate victims of a terrorist attack the size of a Madrid train 2004 bombing. Three of the five Level I trauma centers are in "diversion", meaning ambulances with all the most severely injured patients are being directed elsewhere because ED can not safely accommodate more patients. This controversial practice is banned in Massachusetts (except for major incidents, such as fire in the ER), effective January 1, 2009; in response, hospitals have devoted more staff to ED at busy times and moved some elective procedures to non-peak times.
In 2009, there were 1,800 EDs in the country. In 2011, about 421 out of every 1,000 people in the United States visited the emergency department; five times as many were released as treated. Rural areas are the highest ED visits (502 per 1000 population) and large metro districts have the lowest (319 visits per 1,000 population). By region, the Midwest has the highest ED visits (460 per 1000 population) and the Western State has the lowest (321 visits per 1,000 population).
Most Common Reasons for Visiting Emergency Departments Dumped in the United States, 2011
In addition to the usual hospital-based emergency department, a trend has grown in some states (including Texas and Colorado) from the hospital's unincorporated emergency departments. The new emergency department is called a free-standing emergency department. The rationale for this operation is the ability to operate outside of hospital policies that can lead to increased waiting times and reduced patient satisfaction.
United Kingdom
All A & amp; E departments throughout the United Kingdom are funded and managed publicly by the NHS of each constituent country (England, Scotland, Wales and Northern Ireland). Like most other NHS services, emergency care is provided to all, both citizens and those who normally do not live in the United Kingdom, free at the point of need and regardless of ability to pay.
In the UK department is divided into three categories:
- Type 1 A & amp; E department - Major A & amp; E, provides a 24-hour consultant-contracted service with full resuscitation facility
- Type 2 Department A & amp; E - A & amp; customized service Single E (eg ophthalmology, dentistry)
- Part 3 A & amp; E - A & amp; E/minor injury/other pedestrian center, treat minor injuries and diseases
Historically, waiting for ratings in A & amp; E is very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in the emergency department that required departments in the UK to assess and treat patients within four hours of arrival, with referrals and assessments by other departments if deemed necessary. It is expected that patients will physically leave the department within four hours. The current policy is that 95% of all patient cases do not "break" waiting for these four hours. Britain's busiest departments outside London include University Hospital of Wales in Cardiff, North Wales Regional Hospital in Wrexham, Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth.
In July 2014, the QualityWatch research program publishes an in-depth analysis that tracks 41 million A & E participants during 2010 to 2013. This shows that the number of patients in the department at one time is closely related to the waiting time, and the crowd at A & E has increased as a result of population growth and aging, exacerbated by freezing or reducing A & E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, although the increase was only 3% in A & amp; E, and this trend is likely to continue. Other influential factors identified by the report include temperatures (with hotter and cooler temperatures driving A & amp; E) visits, staff numbers and inpatient beds.
A & E services in the UK are often the focus of many media and political interests, and data on A & amp; E published weekly. However, this is only one part of a complex emergency and urgent care system. Therefore, reducing the waiting time of A & amp; E requires a comprehensive and coordinated strategy in various related services.
Many A & E departments are busy and confusing. Many of those present are very anxious, and some are mentally ill, and especially at night under the influence of alcohol or other substances. Pearson Lloyd's redesign - 'A Better A & amp; E '- claimed to have reduced aggression against hospital staff in the department by 50 percent. The environmental marker system provides location-specific information for the patient. The screen provides direct information about how many cases are handled and the current status of the A & amp; E. Waiting time for patients to be seen at A & amp; E has increased.
Critical conditions handled
Cardiac arrest
Cardiac arrest may occur in ED/A & E or patients may be transported by ambulance to an emergency department already in this state. Treatment is a basic life support and life support continuation as taught in life support and advanced heart life support courses.
Heart attack
Patients who come to the emergency department with myocardial infarction (heart attack) are likely to be prioritized into the resuscitation area. They will receive oxygen and monitoring and have an early EKG; aspirin will be given if it is not contraindicated or has not been managed by the ambulance team; morphine or diamorphine will be given for pain; sub lingual (under the tongue) or buccal (between the cheeks and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs, such as drugs that treat erectile dysfunction.
An ECG that reveals the ST segment elevation or the new left bundle branch block indicates the total blockage of one of the major coronary arteries. These patients require direct reperfusion (reopening) of clogged vessels. This can be achieved in two ways: thrombolysis (clot bust) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in significantly reducing the mortality of myocardial infarction. Many centers are now turning to the use of PTCA because it is somewhat more effective than thrombolysis if it can be given earlier. This may involve transfer to a nearby facility with facilities for angioplasty.
Trauma
Major trauma, the term for patients with multiple injuries, often from motor vehicle accidents or major falls, was initially addressed in the Emergency Department. However, trauma is a specialization (surgery) separate from emergency medicine (which is a medical specialty, and certified in the United States of the American Board of Emergency Medicine).
Trauma is handled by trauma teams who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course at the American College of Surgeons. Several other international training agencies have started running similar courses on the same principles.
The services provided in the emergency department can range from x-rays and the arrangement of damaged bones to a full-scale trauma center. The chance of a patient to survive greatly increases if the patient receives definitive treatment (ie surgery or reperfusion) within an hour after an accident (such as a car accident) or the onset of an acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour".
Several emergency departments in smaller hospitals are located near a helipad used by helicopters to transport patients to the center of trauma. Inter-hospital transfers are often performed when a patient needs advanced medical care not available at a local facility. In such cases, emergency departments can only stabilize the patient for transportation.
Mental illness
Some patients arrive at the emergency department for mental illness complaints. In many jurisdictions (including many US states), patients who appear mentally ill and present a danger to themselves or others may be brought against their will to the emergency department by law enforcement officers for psychiatric examination. Emergency departments perform medical examinations rather than treat acute behavioral disorders. From the emergency department, patients with significant mental illness can be transferred to a psychiatric unit (in most cases involuntarily).
Asthma and COPD
Acute exacerbations of chronic respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have emergency chest X-rays and arterial blood gases and are referred for intensive care. be careful if necessary. Noninvasive ventilation in the ER has reduced the need for tracheal intubation in many cases of COPD exacerbations.
Facilities, training, and specialized tools
ED requires different tools and approaches that are different from most other hospital divisions. Patients often come with unstable conditions, so it should be dealt with quickly. They may be unaware, and information such as their medical history, allergies, and blood type may not be available. ED staff are trained to work quickly and effectively even with minimal information.
ED staff should also interact efficiently with pre-hospital care providers such as EMTs, paramedics, and others that are sometimes based on ED. Pre-hospital providers may use equipment unknown to the average physician, but ED doctors must be experts at using (and safely disposing) of specialized equipment, since devices such as military anti-shock pants ("MAST") and traction splinting require special procedures. Among other reasons, given that they should be able to handle special equipment, doctors can now specialize in emergency medicine, and ED employs many specialists.
ED staff have much in common with ambulance and fire-fighters, combat medical officers, search and rescue teams, and disaster response teams. Often, joint exercises and practice exercises are organized to improve the coordination of this complex response system. ED is busy exchanging lots of equipment with the ambulance crew, and both must provide for replacing, returning, or replacing expensive items.
Cardiac arrest and major trauma are relatively common in ED, resulting in defibrillators, automatic ventilation and CPR machines, and bleeding control dressings strongly used. Survival in such cases is greatly enhanced by shortening waits for major interventions, and in recent years some of these specialized tools have spread to pre-hospital settings. The most notable example is the defibrillator, which first spreads to the ambulance, then in automatic versions to police cars and firefighting apparatus, and lastly to public spaces like airports, office buildings, hotels, and even shopping malls.
Because time is an important factor in emergency care, ED usually has its own diagnostic equipment to avoid waiting for equipment to be installed elsewhere in the hospital. Almost all have radiographic examination rooms managed by specialized radiographs, and many now have complete radiological facilities including CT scanners and ultrasound equipment. Laboratory services can be handled on a priority basis by the hospital lab, or ED may have its own "STAT Lab" for basic laboratories (blood count, blood typing, toxicology screen etc.) that should be returned very quickly.
Non-emergency use
Metrics that apply to ED can be grouped into three main categories, volume, cycle time, and patient satisfaction. Metric volumes include hourly arrivals, percentage of ED beds occupied and the patient's age understood at the basic level in all hospitals as an indication for employment requirements. Cycle time metrics are a mainstay of evaluation and tracking of process efficiencies and are less widespread because active effort is needed to collect and analyze these data. Patient satisfaction metrics, already commonly collected by nursing groups, groups of doctors and hospitals, are useful in demonstrating the impact of changes in patient perceptions about treatment over time. Because patient satisfaction metrics are derivative and subjective, they are less useful in primary process improvement. The exchange of health information may reduce non-insurgent ED visits by providing up-to-date data on admissions, deliveries and transfers to health plans and responsible care organizations, allowing them to shift ED use to primary care settings.
In all Primary Care Trusts, there is an hour-long medical consultation provided by a general practitioner or nursing practitioner.
In the United States, and many other countries, hospitals are starting to create areas in the emergency room for people with minor injuries. This is usually referred to as Fast Track or Minor Care units. These units are for people with non-life-threatening injuries. The use of these units within a department has been shown to significantly improve the flow of patients through the department and to reduce waiting times. Emergency care clinics are another alternative, where patients can immediately receive treatment for non-life-threatening conditions. To reduce the strain on limited ED resources, the American Medical Response creates a checklist that allows EMT to identify a drunk individual who can safely be sent to a detox facility instead.
Excess
The addition of the emergency department is when the function of the department is hindered by the inability to treat all patients in an adequate manner. This is a common occurrence in the emergency department around the world. Excess leads to inadequate patient care leading to worse patient outcomes. To overcome this problem, escalation policies are used by emergency departments when responding to increased demand (eg, sudden entry of patients) or capacity reduction (eg, lack of beds to receive patients). The policy aims to maintain the ability to provide patient care, without sacrificing safety, by modifying the 'normal' process.
Emergency department wait time
The emergency waiting time (ED) has a serious impact on patient mortality, morbidity with re-enrollment in less than 30 days, length of stay, and patient satisfaction. A literature review exposes the logical reason that because treatment outcomes for all illnesses and injuries are time sensitive, the sooner the treatment is given, the better the results. Studies have reported a significant relationship between waiting time and mortality and higher morbidity among those who survive. It is clear from the literature that hospital premature death and morbidity can be reduced by reduction of ED waiting time.
Exit block
While most people who attend emergency departments are returned home after treatment, many require permission for ongoing observations or treatments, or to ensure adequate social care before possible. If the person requiring admission can not be moved to the inpatient bed quickly, an "outbound block" or "access block" occurs. This often leads to crowding and destroys the flow to the point that it may cause delays in proper care for newly emerging cases ("access block of arrival"). This phenomenon is more common in densely populated areas, and affects fewer pediatric departments than adults.
Outbound blocks can cause delays in care both to people waiting for boarding beds and those newly arrived to blocked departments. Various solutions have been proposed, such as staff changes or in-patient capacity upgrades.
Frequent presenters
Frequent presenters are people who will appear in the hospital several times, usually with complex medical needs or with psychological problems that complicate medical management. These people contribute to overcrowding and usually require more hospital resources even though they do not take into account the significant number of visits. To help prevent improper emergency and return visits, some hospitals offer care coordination and support services such as primary care at home and in temporary shelters for frequent presenters and short-term housing for homeless patients who are recovering after discharge.
Emergency Department in military
Emergency departments in the military receive additional support from enlisted personnel capable of performing various tasks that have been trained for them through special military schools. For example, at the United States Military Hospital, Air Force Aerospace Medical Technicians and Naval Corps Hospital perform tasks that fall within the scope of the practice of both doctors (ie stitches, staples and incisions and drains) and nurses (eg drug administration, foley catheter insertion ), and gain intravenous access) and also splinting of the injured extremity, insertion of nasogastric tubes, intubation, cauterization wounds, eye irrigation, and more. Often, some civil education and/or certification will be required such as EMT certification, in case of need to provide care outside the base where the member is placed. The presence of highly trained trained personnel in the Emergency Department drastically reduces the workload on nurses and doctors.
According to a survey in downtown urban care center in Vancouver, 57% of health care workers were physically assaulted in 1996. 73% fear of patients due to violence, nearly half, 49%, hiding their identities from patients, 74% have reduced job satisfaction. More than a quarter of respondents took days off because of violence. Respondents no longer work in the emergency department, 67% reported that they had left work at least partly because of the violence. Twenty-four hour security and workshops on violent prevention strategies are perceived as the most useful potential interventions. Physical exercise, sleep and family and friend companies are the most frequently cited coping strategies by those surveyed.
Medication error
Treatment errors are a problem that causes inappropriate drug distribution or potentially harmful to the patient. In 2014, about 3% of all hospital ill effects are due to treatment errors in the emergency department (ED); between 4% and 14% of the medications administered to patients in ED are wrong and children are very risky.
Mistakes can arise if the doctor prescribes the wrong medicine, if the prescribed prescription by the doctor is not actually communicated to the pharmacy due to an unclear written recipe or an incorrect verbal command, if the pharmacy is handing out the wrong drug, or if the drugs this is then given to the wrong person.
ED is a risky environment than any other area in the hospital because medical practitioners are unaware of patients as well as they know long term hospital patients, due to time pressures caused by density, and because of the emergency nature of the drugs practiced there.
See also
- The emergency department in France
- Acute Assessment Unit
- Emergency medical services
- Clinic runs
Note
References
- John B Bache, Carolyn Armitt, Cathy Gadd, Emergency Department Procedure Handbook , ISBN 0-7234-3322-4
- Swaminatha V Mahadevan, Introduction To Clinical Emergency Medicine: A Guide for Practitioners in the Emergency Department , ISBNÃ, 0-521-54259-6
- Academic Emergency Medicine, ISSN 1069-6563, Elsvier
External links
- Use of the emergency department for less or less urgent care (Canada) (Canadian Institute for Health Information)
- Excessive Emergency Use by California Insiders (USA) (California HealthCare Foundation, October 2006)
- Visit ED (US) (National Health Statistics Center)
- Academic Emergency Medicine, ISSN 1069-6563, Elsvier
- Doctor on Call: California Patchwork Approach to Emergency Department Coverage
- Medical Treatment Waiting Time at Emergency Department Hospital, 2009. Hyattsville, Md.: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2012.
- Friday Night in ER (Simulation game and educational program about Emergency Department crowd)
Source of the article : Wikipedia
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