BackgroundCrowding in hospital Emergency Departments (EDs) is a commonly observed problem in all over the world. Although the reasons and mechanisms are different, the major factors are increasing volume of patients seeking medical care in ED services, lack of inpatient beds, and care for non-urgent conditions for patients who identify the ED as their easiest and usual site of care, notwithstanding the typical treatment of patients with serious illnesses or injuries, non availability and accessibility of other medical services in the community.ObjectiveTo identify the factors related to patients unscheduled revisit in ED, to find out average length of stay in different priority patients and to identify the reason for more than 6 hours stay in ED.MethodsThe alkhor hospital has 110 bed capacities in the north part of Qatar with an annual ED patient volume of 158000.A prospective study conducted during two months periods from 15/09/2014 to 14/11/2014 in ED. The census sample of patients who had revisit within 72 hours of discharge from the ED was recruited in the Study. CERNER system utilized to collect all revisit patients data including demographic and first visit information. Two experts from ED consultants reviewed the data independently. Further data include average length of stay and reason for more than 6 hours stays in ED were collected by the research team and all the data was analyzed by the author. The factors were categorized in to four types includes: physician related: missed diagnosis, not prescribed medications, treatment error/ patient related: perception of not improved/illness related: complications of disease process, prognosis of disease process/system related: not availability of health care, not availability of health center locally.ResultsDuring study period 24933 patients visited in ED, 849 were revisited within 72 hours of their discharge which accounts 3.4%. 165 were excluded from the study which includes LWBS,DAMA and absconded patients. The characteristic of revisited patients, more likely young adults between 20–40 years of age (59.79%). Mostly males (78.94%) expatriate (69.73%) 30.27% patient had three visit in ED while 69.73% twice visited. The most of the patients (538) were self-reported in ED during their second visit. The vast majority of patients (542) agreed that they received discharge instructions.Physician related Factors includes: this includes missed diagnosis (1.6%), adverse drug reaction ((1.3%) and discharged without home medication (8.4%)Patient related: The 60.26% (331) of the patients perceived that they were not improved with initial treatment. However, among these patients only 8 were admitted in Alkhor hospital and one transferred to another health care facility for expert management. The vast majority of the patients 97.2% patients were discharge from the ED.Illness related: This was the most common reason for revisit in ED, 52.9% (362) return with same complaints while 21.3% (146) with related complaints in which 97.6% patients were discharged and 1.3% (7) admitted in hospital 22.8% (156) patients reported in ED with new complaint.System related: The 23.49% revisited patient's living in Alkhor or nearby area, with their primary health center facility 70 km away from their residential area. 30% patients have no health center facility for further follow up. This cause high financial burden for low income workersDuring the study period 718 patients found stayed more than 6 hours in ED, which accounts 2.87% of the total ED patients, mean age of 35.43 years. Most of the patients were males (93.3%). The vast majority of patients were priority 3 and 4 which accounts 26.6% and 63.6 % respectively. The mean times for triage and physician assessment were 2.538 hours and 2.571 hrs accordingly and length of stay in ED was 8.365 hrs. The top 5 reasons for delay the patient in ED was waited for assessment by physician (26.3%), waiting for reassessment by physician (20.2%) observation (11.3%) waited for triage by nurse (8.6%) and repeat lab works (8.2%).The revisited patients distributed unequally in the three shift duty hours. The morning (7 am–15 pm) and evening (15 pm–23 pm) shifts received the highest proportion 43.12% (295) and 38.45(263) compared to night shift (23 pm–7 am) 15.05% (103). Whereas on daily basis of revisited patients maintained almost equal distribution.In general the average length of stay of priority 2 patients was 2 hours 14 mts, priority 3 was 2 hrs 17 mts where as priority 4 and 5 was 2 hrs 27 mts and 1 hour 54 mts respectivelyConclusionThe patients decision to revisit in ED is complex, it include several factors like poor quality of service, missed diagnosis, financial factors, disease process etc. From our study we found majority of revisit due to illness or system related factors like their perception of disease progress, lack of local health center facility for workers, financial burden etc. Effective educational program and initiation of tele nursing service for discharged patients can avoid unnecessary ED visits.
Introduction: Colorectal cancer is the second leading cause of cancer-related death in the US; complete surgical resection is the only curative treatment for non-metastatic colorectal cancer (NMCC). Postoperative ileus (POI) frequently increases patient morbidity and healthcare costs. Enhanced recovery after surgery (ERAS) protocol is the standard of care in most institutions and has been shown to reduce postoperative complications, but there is no a completely effective treatment for this condition. Studies suggest that electroacupuncture (EA) can improve gastrointestinal tract function after surgery. Objective: We aim to determine if including EA to the standard treatment of POI decreases the time to the first defecation, enhancing the return of normal bowel function after colon resection for NMCC. Methods: We propose a phase II, single-center, randomized, triple-blinded, sham-controlled trial with two parallel arms and a 1:1 allocation ratio. Patients 40-80 years of age diagnosed with NMCC scheduled to undergo laparoscopic surgery for colon cancer resection will be included. The arms will be EA + standard treatment and sham EA + standard treatment. The standard treatment will follow the ERAS protocol. Discussion: This will be the first randomized clinical trial to evaluate the impact of using EA along with the ERAS protocol for POI. This intervention may reduce patient morbidity and improve healthcare costs associated with the disease.
The invasion of the novel coronavirus disease quickly overshadowed the international year of the nurses and the aftereffects of COVID-19 have continued to reverberate around the world (LoGiudice & Bartos, 2021). Nurses are the biggest workforce within healthcare systems and an integral part of the management of COVID-19 pandemic (Shechter et al., 2020).Uncertainty was the main challenge to nurses that covered a wide range of concerns including, lack of information about COVID-19, changing policies, misinformation and concerns about PPE shortages, stigmatization by the public and concerns of infecting families (Preti et al., 2020). Besides the challenge to keep patients and their families safe, the emotional challenges of nurses included fear, anxiety, exhaustion, frustration, guilt and loneliness (Nelson et al., 2021). Nurses also experienced acute stress and depressive symptoms (Shechter et al., 2020). Anxieties appear to be limited to the acute phase of pandemic exposure, but life stress and burnout can be ongoing after the pandemic (Preti et al., 2020). Individuals' reactions and coping strategies differ when they are exposed to stressful incidents and events. While some react negatively to stressful and traumatic situations, resulting in psychological distress, others quickly overcome the negative mental state and return to their normal lives (LeDoux & Gorman, 2001). This may empower people who can recover and resume their lives, which is referred as psychological resilience (Slavich et al., 2021). During the COVID-19 pandemic, resilience strategies can help to alleviate emotional and psychological harm and pave the way for recovery and personal growth (Greenberg et al., 2020).
Background: Prompt recognition and reporting of Medication Administration Errors (MAE) are paramount in ensuring patient safety in hospitals. The data on under-reporting MAE in Middle East Area is limited. Aim: The study intended to estimate the percentage of fear factor and explore the perception of nursing professionals regarding the reason for the occurrence and underreporting of MAE. Design: A cross-sectional design was utilized to conduct the current study. Place and Duration of Study: The study was conducted in eight hospitals working under Public health sector of Qatar between August and September 2016 Methodology: The data were collected with a purposive sample of 487 clinical nurses employed by the public health sector of Qatar who responded to a pre-designed online questionnaire. Results: The perceived prevalence of fear factor in non-reporting MAE was 23.45%, 95% confidence interval (C.I).: 16% to 33%. The single factor confirmatory factor analysis (CFA) model explained 65% of the variance in the fear factor of nonreporting of medication administration errors. The highest mean score in the subscale of reasons for non-reporting of MAEs includes fear (mean 0.652±1.671) and administrative responses (mean 0.304±1.466), and reporting processes (mean -0.505±1.669), whereas disagreement over hospital definition (mean -1.158±1.528) of error was the least significant reason for nonreporting of MAE by the clinical nurses. Conclusion: The study focuses on quantifying the fear factor and underscores the Nurses' fear about the professional consequences of reporting MAE. The findings in this study not only provide evidence concerning the fear of reporting MAE but also shed light on the contributing factors and reasons for the nonreporting of MAE. Nursing leadership needs to concentrate on modifying existing strategies and policies to more comprehensible approaches to reporting errors.
Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in environments. Methods: A cross center mixed methodology study looking at back pain in nurses working in critical care environments data collection included demographic, occupational, and health characteristics and a Likert questionnaire. This comprised of 10 questions relating to manual handling education, equipment, staffing levels and ergonomics and was distributed in critical care and emergency departments across five hospital sites responses rate n = 450. Results: Outcome data identified 65% of the respondents reported experiencing back pain over the last year with subsequent negative impact on quality of life. There was statically significant association between gender and quality of life p = 0.001; with more women verbalizing a negative impact on quality of life secondary to back pain. There were also statically significant relationships between age with younger age group reporting negative impact on quality of life p = 0.001 and length of time employed in HMC with respondents who have been employed between 1–5 years experiencing the greatest impact p = 0.001. Conclusions: Back pain is an under reported occupational health concern that impacts on productivity and quality of life. Mandatory training in manual handling should feature in corporate educational agenda. Occupational health initiatives' are essential in the management of chronic health conditions.
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