| Abstract |
Introduction: The patients who visit hospital and their condition severity are constantly in-creasing in our country in recent years Reasons for this increase aging of population, insuffi-cient organization of Primary Care, increasing numbers of visitors (tourists, economic mi-grants),and increased despatches from other hospitals. This has results to large numbers of all kinds of patients visiting the ED. Many patients need immediate and timely proper management in Emergency Medicine personnel
The aim: The aim of this study was to record 48-hour outcome of adult and pediatric patients admitted in the Hospital though an ED triage enrolment and its association with disease severity triage coding, waiting times, registered diagnosis and other clinical indicates and the work-load the respective departments.
Other aims are to associate mortality with various risk factors during the 48-hours of hospitaliza-tion
Compare the doctors’ competence diagnosis: initial registration diagnosis and to the 48-hour of the clinic diagnosis.
Compare waiting times in the Emergency department imprinted with the average times to interna-tional reports.
Material and method: This is a prospective study, that took place of the University Hospital of Heraklion, Crete. Recorded patients that admitted to Pathological and Paediatric clinic via Emer-gency Department (ED) PAGNI during the period 15th July to 31st October 2017.
Patients were enrolled in a protocol gender (attached from approved by the Board Directors’ deci-sion of PAGNI No 211 of 18002-2015)
All patients who admitted via ED into Pathological and Paediatric department respectively on call-days were included. The data collection was done by identifying registrations from Med-line Web database of PAGNI. Information was collected via platform database IATROS of EKAV of Crete.
In the protocol, the study’s markers were recorded from the patients’ initial ED card and clinics’ medical archives respectively. Demographic related to indicators statistics (patients’ code, gender, age, and nationality), arrival time/register time, and admitted time.
Also recorded the way patients came at the Hospital, by themselves, by ambulance, by Special Am-bulance Units of Pre-hospital Emergency Medicine or other. It was noted whether pre- hospital treatment or treatment was provided by EKAV staff, reception consulting in department office and patient’s vital signs after its arrival in ED. Also, entered doctors’ initial ED diagnosis, 48-hour. clinic diagnosis during hospitalization, recorded patients’ last year referrals at ED and their co-morbidity.
The 48-hour outcome was recorded as: Improvement (discharge), Remaining (hospitalization), internal transfer to another department, admission in ICU, or Death.
Results: Of 501 pathological individuals recorded 50.1% were women with an average age 75 years and 49.3% of men’s average age was 71 years (p<0.001).The patients’ Length of Stay in ED was 6,36 hours ( patients who remain in inpatient Short Stay Care Unit had LOS 5,07 hours, but patient who went through ED and were admitted directly in Pathological department had LOS 1,29 hours. The patients’ survival was statically significant (p< 0.001) for those who were hospitalized to Short Stay Care Unit for a longer period. Mortality wasn’t associated with patients’ arrival time and their stay in Short Stay Care Unit there was no statistically significant difference (NS). Initial diagnosis of ED doctors’ and 48-hour clinical agreement diagnosis was 65.99% (324 individuals), 3.6% (19 individuals) was disagreement diagnosis and 30.35% (145 individuals) was relevant diagnosis. In 48-hour sample outcome 376 individuals (75.5%) remain hospitalized, 85 individuals (17.1%) dis-charged, 20 (4%) died and 11 individuals (2.2%) transfer internal to another department, 3 individuals (0.6%) admitted in ICU, also 3 patients (0.6%) discharged illegally. The 48-hour patients’ outcome wasn’t statistical significant with co-morbidity (NS), wasn’t statistical significant with previous referrals in ED (NS) and their dispatch from Center of Primary Care. In the 48-hour outcome statistically significant (p<0.001) was the characterization of ambulances’ severity evacuation of patients in the hospital.
Of the 413 paediatric patients the 74% were Greek, 14% were tourists and 12% were immigrants.
Forty eight % were girls and 52% were boys with the highest percentage of the sample being pre-schoolers. The days with the most admissions were Tuesday and Saturday with no significant statis-tical difference (NS). The highest number of patients was admitted between 18:00 pm and 00:00 am at midnight (p<0.001). Average time of children’s ED Length Of Stay was 0.59 hours. ED doctors’ initial diagnosis and 48-hour clinical agreement diagnosis was 52% (213 children) agreement diag-nosis, 22 %( 90 children) disagreement, and 26% (106 children) had relevant diagnosis. The chil-dren’s outcome at 48-hour showed that 60% (249 individuals) discharged , a 32% (133) remained hospitalized and 3% (12) transferred internal to another department, while 5% (19) discharged of their own.
Conclusion: Our study demonstrates that increased workload in the Department of Internal Medi-cine with 75% of the patients remaining hospitalized, 4% died and only o.6% patients’ transferred to the ICU or other departments. Patients’ Length of Stay exceeds the recommended four hour period. Remaining in The Short Care Unit was shown to be vital and statistically significant for patients’ survival. The use of ambulance may be considered increased however must be underlined that the patients’ 48-hour outcome was related as with predictive value of gravity indicator of EMS. In the paediatric sample patients had ED’s Length of Stay less than an hour and the discharge rate was better than pathological sample. The agreement of diagnosis between initial and that 48-hour diagnosis was up of 50% in both population.
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Εξέλιξη 48ώρου ασθενών που εισήχθησαν από το ΤΕΠ στην Παθολογική και την Παιδιατρική Κλινική
