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Varios términos redirigen aquí. Para otros usos, consulte Accidentes y emergencias (desambiguación) , Sala de emergencias (desambiguación) y Sala de emergencias (desambiguación) .
"Resus" vuelve a dirigir aquí. No debe confundirse con Rhesus . Para reanimación, consulte Reanimación cardiopulmonar .

El área principal para pacientes dentro de la Unidad Médica Móvil operada en Belle Chasse, Louisiana

Un departamento de emergencias ( ED ), también conocido como departamento de accidentes y emergencias ( A&E ), sala de emergencias ( ER ), sala de emergencias ( EW ) o departamento de urgencias , es un centro de tratamiento médico especializado en medicina de emergencia , la atención aguda de pacientes que presente sin cita previa; ya sea por sus propios medios o por el de una ambulancia . El departamento de emergencias generalmente se encuentra en un hospital u otro centro de atención primaria .

Debido a la naturaleza no planificada de la asistencia del paciente, el departamento debe proporcionar tratamiento inicial para un amplio espectro de enfermedades y lesiones, algunas de las cuales pueden poner en peligro la vida y requieren atención inmediata. En algunos países, los departamentos de emergencia se han convertido en importantes puntos de entrada para quienes no tienen otros medios de acceso a la atención médica.

Los departamentos de emergencia de la mayoría de los hospitales funcionan las 24 horas del día, aunque los niveles de personal pueden variar en un intento de reflejar el volumen de pacientes.

Historia [ editar ]

Los planes de compensación para trabajadores, las empresas ferroviarias y los municipios de Europa y Estados Unidos ya proporcionaban servicios en caso de accidentes a finales del siglo XIX, pero el primer centro especializado en atención traumatológica del mundo se abrió en 1911 en los Estados Unidos en la Universidad. del Hospital de Louisville en Louisville, Kentucky , y fue desarrollado por el cirujano Arnold Griswold durante la década de 1930. Griswold también equipó a los vehículos de policía y bomberos con suministros médicos y capacitó a oficiales para brindar atención de emergencia mientras se dirigían al hospital. [1] [2]

Hoy en día, un hospital típico tiene su departamento de emergencias en su propia sección de la planta baja del terreno, con su propia entrada dedicada. Como los pacientes pueden llegar en cualquier momento y con cualquier queja, una parte clave del funcionamiento de un servicio de urgencias es la priorización de los casos en función de la necesidad clínica. [3] Este proceso se llama triaje .

El triaje es normalmente la primera etapa por la que pasa el paciente y consiste en una evaluación breve, que incluye un conjunto de signos vitales y la asignación de una "queja principal" (por ejemplo, dolor de pecho, dolor abdominal, dificultad para respirar, etc.). La mayoría de los departamentos de emergencia tienen un área dedicada para que se lleve a cabo este proceso y pueden tener personal dedicado a realizar nada más que una función de triaje. En la mayoría de los departamentos, esta función la desempeña una enfermera de triaje , aunque depende de los niveles de capacitación en el país y el área, otros profesionales de la salud pueden realizar la clasificación de triaje, incluidos los paramédicos y médicos.. La clasificación se realiza normalmente cara a cara cuando el paciente se presenta, o se puede realizar una forma de clasificación por radio con un equipo de ambulancia; en este método, los paramédicos llamarán al centro de triaje del hospital con una breve actualización sobre un paciente entrante, que luego será asignado al nivel de atención adecuado.

La mayoría de los pacientes serán evaluados inicialmente en el triaje y luego pasados ​​a otra área del departamento, u otra área del hospital, con el tiempo de espera determinado por su necesidad clínica. Sin embargo, algunos pacientes pueden completar su tratamiento en la etapa de triaje, por ejemplo, si la afección es muy leve y puede tratarse rápidamente, si solo se requiere asesoramiento o si el departamento de emergencias no es un punto de atención adecuado para el paciente. Por el contrario, los pacientes con afecciones evidentemente graves, como un paro cardíaco, evitarán el triaje por completo y se trasladarán directamente a la parte correspondiente del departamento.

El área de reanimación , comúnmente conocida como "Trauma" o "Resus", es un área clave en la mayoría de los departamentos. Los pacientes más gravemente enfermos o heridos serán tratados en esta área, ya que contiene el equipo y el personal necesarios para tratar las enfermedades y lesiones que amenazan la vida de inmediato. El personal de reanimación típico involucra al menos un médico tratante y al menos una y generalmente dos enfermeras con trauma y soporte vital cardíaco avanzadocapacitación. Este personal puede ser asignado al área de reanimación durante la totalidad del turno o puede estar "de guardia" para la cobertura de reanimación (es decir, si se presenta un caso crítico a través del triaje sin cita previa o ambulancia, el equipo será llamado al área de reanimación para tramitar el caso de inmediato). Los casos de reanimación también pueden ser atendidos por residentes , radiógrafos , personal de ambulancia , terapeutas respiratorios , farmacéuticos del hospital y estudiantes de cualquiera de estas profesiones, según la combinación de habilidades necesarias para cada caso y si el hospital proporciona o no servicios de enseñanza.

Los pacientes que muestren signos de estar gravemente enfermos, pero que no corran peligro inmediato de muerte o de una extremidad, serán asignados a "cuidados intensivos" o "especializaciones", donde serán atendidos por un médico y recibirán una evaluación y un tratamiento más completos. Ejemplos de "especialidades" incluyen dolor de pecho, dificultad para respirar, dolor abdominal y molestias neurológicas. En esta etapa se pueden realizar pruebas de diagnóstico avanzadas, incluidas pruebas de laboratorio de sangre y / u orina, ecografía , tomografía computarizada o resonancia magnética . También se administrarán medicamentos apropiados para controlar la condición del paciente. Dependiendo de las causas subyacentes de la queja principal del paciente, es posible que sea dado de alta desde esta área o ingresado en el hospital para recibir tratamiento adicional.

Los pacientes cuya afección no ponga en peligro su vida de inmediato serán enviados a un área adecuada para tratarlos, y estas áreas generalmente se denominan áreas de atención inmediata o de menores . Es posible que aún se haya encontrado que estos pacientes tienen problemas importantes, que incluyen fracturas , dislocaciones y laceraciones que requieren sutura .

Los niños pueden presentar desafíos particulares en el tratamiento. Algunos departamentos tienen áreas de pediatría dedicadas , y algunos departamentos emplean un terapeuta de juego cuyo trabajo es tranquilizar a los niños para reducir la ansiedad causada por visitar el departamento de emergencias, así como brindar terapia de distracción para procedimientos simples.

Muchos hospitales tienen un área separada para la evaluación de problemas psiquiátricos . Estos suelen estar integrados por psiquiatras, enfermeras de salud mental y trabajadores sociales . Por lo general, hay al menos una habitación para las personas que presentan un riesgo activo para ellas mismas o para los demás (por ejemplo, suicidas ).

Las decisiones rápidas sobre casos de vida o muerte son fundamentales en los departamentos de emergencia de los hospitales. Como resultado, los médicos enfrentan grandes presiones para sobreestimar y tratar en exceso. El miedo a perderse algo a menudo conduce a análisis de sangre adicionales y escaneos de imágenes para lo que pueden ser dolores de pecho inofensivos, golpes en la cabeza comunes y corrientes y dolores de estómago no amenazantes, con un alto costo para el sistema de atención médica. [4]

Nomenclatura en inglés [ editar ]

El departamento de emergencias se usó comúnmente cuando la medicina de emergencia fue reconocida como una especialidad médica, y los hospitales y centros médicos desarrollaron departamentos de medicina de emergencia para brindar servicios. Otras variaciones comunes incluyen 'sala de emergencia', 'centro de emergencia' o 'unidad de emergencia'.

"Accidente y emergencia" o "A&E" es el término más común en el Reino Unido, [5] y en algunos países de la Commonwealth , [ cita requerida ] al igual que términos anteriores como "Siniestro" o "sala de accidentes", que siguen siendo utilizado informalmente. Lo mismo se aplica a la 'sala de emergencias', 'emerg' o 'ER' en América del Norte, que se originó cuando el departamento de cirugía proporcionó instalaciones de emergencia en una sola habitación del hospital.

Señalización [ editar ]

Independientemente de la convención de nomenclatura, existe un uso generalizado de la señalización direccional en texto blanco sobre un fondo rojo en todo el mundo, lo que indica la ubicación del departamento de emergencias o un hospital con tales instalaciones.

Los letreros en los departamentos de emergencia pueden contener información adicional. En algunos estados de Estados Unidos, existe una estricta regulación del diseño y contenido de tales letreros. Por ejemplo, California requiere una redacción como "Servicio médico integral de emergencia" y "Médico de guardia", [6] para evitar que las personas que necesitan cuidados intensivos se presenten en instalaciones que no están completamente equipadas y con personal.

En algunos países, incluidos los Estados Unidos y Canadá, una instalación más pequeña que puede brindar asistencia en emergencias médicas se conoce como clínica . Las comunidades más grandes a menudo tienen clínicas sin cita previa donde se puede atender a personas con problemas médicos que no se considerarían lo suficientemente graves como para justificar una visita al departamento de emergencias. Estas clínicas a menudo no funcionan las 24 horas. Las clínicas muy grandes pueden funcionar como "centros de emergencia independientes", que están abiertos las 24 horas y pueden manejar una gran cantidad de afecciones. Sin embargo, si un paciente se presenta en una clínica independiente con una afección que requiere ingreso hospitalario, debe ser trasladado a un hospital real, ya que estas instalaciones no tienen la capacidad para brindar atención hospitalaria.

  • Ejemplos de señalización del departamento de emergencias

  • Centro Médico del Valle de Santa Clara .

  • Hospital Mayo Clinic en Rochester .

  • Señalización trilingüe en francés, holandés e inglés en un servicio de urgencias en Bruselas , Bélgica .

Estados Unidos [ editar ]

Los Centros de Servicios de Medicare y Medicaid (CMS) clasificaron los departamentos de emergencia en dos tipos: Tipo A, la mayoría, que están abiertos las 24 horas del día, los 7 días de la semana, los 365 días del año; y los que no lo son, Tipo B. Muchos departamentos de emergencia de EE. UU. están extremadamente ocupados. Un estudio encontró que en 2009, hubo un estimado de 128,885,040 visitas al DE en hospitales de EE. UU. Aproximadamente una quinta parte de las visitas al servicio de urgencias en 2010 fueron para pacientes menores de 18 años. [7] En 2009-2010, personas de 65 años o más realizaron un total de 19,6 millones de visitas al departamento de emergencias en los Estados Unidos. [8] La mayoría de los encuentros (82,8 por ciento) resultaron en tratamiento y liberación; El 17,2 por ciento ingresó a la atención hospitalaria. [9]

La Ley de tratamiento médico de emergencia y trabajo de parto activo de 1986 es una ley del Congreso de los Estados Unidos que exige que los departamentos de emergencia, si el hospital asociado recibe pagos de Medicare , proporcionen el examen médico y el tratamiento de emergencia adecuados a todas las personas que buscan tratamiento para una afección médica. independientemente de su ciudadanía, estado legal o capacidad de pago. Al igual que un mandato no financiado , no hay disposiciones de reembolso.

Las tasas de visitas al servicio de urgencias aumentaron entre 2006 y 2011 para casi todas las características y ubicaciones de los pacientes. La tasa total de visitas al servicio de urgencias aumentó un 4,5% en ese tiempo. Sin embargo, la tasa de visitas de pacientes menores de un año disminuyó un 8,3%. [10]

Una encuesta de médicos del área de Nueva York en febrero de 2007 encontró que las lesiones e incluso las muertes han sido causadas por la espera excesiva de las camas de hospital por parte de los pacientes del DE. [11] Una encuesta de pacientes de 2005 encontró un tiempo de espera promedio en el servicio de urgencias de 2,3 horas en Iowa a 5,0 horas en Arizona. [12]

Una inspección de los hospitales del área de Los Ángeles realizada por personal del Congreso encontró que los servicios de urgencias operaban a un promedio del 116% de su capacidad (lo que significa que había más pacientes que los espacios de tratamiento disponibles) con camas insuficientes para acomodar a las víctimas de un ataque terrorista del tamaño del tren de Madrid de 2004 bombardeos . Tres de los cinco centros de trauma de Nivel I estaban en "desviación", lo que significa que las ambulancias con todos los pacientes menos los más gravemente heridos se dirigían a otra parte porque el servicio de urgencias no podía acomodar con seguridad a más pacientes. [13] Esta controvertida práctica fue prohibida en Massachusetts (a excepción de incidentes importantes, como un incendio en el ED), a partir del 1 de enero de 2009; en respuesta, los hospitales han dedicado más personal al servicio de urgencias en las horas pico y han trasladado algunos procedimientos electivos a horas no pico.[14] [15]

En 2009, había 1.800 DE en el país. [16] En 2011, alrededor de 421 de cada 1,000 personas en los Estados Unidos visitaron el departamento de emergencias; cinco veces más fueron dados de alta que ingresados. [17] Las áreas rurales tienen la tasa más alta de visitas a los servicios de urgencias (502 por cada 1000 habitantes) y los grandes condados metropolitanos tuvieron la más baja (319 visitas por cada 1000 habitantes). Por región, el Medio Oeste tuvo la tasa más alta de visitas al servicio de urgencias (460 por cada 1000 habitantes) y los estados occidentales tuvieron la más baja (321 visitas por cada 1000 habitantes). [17]

Razones más comunes para las visitas al departamento de emergencias dadas de alta en los Estados Unidos, 2011 [17]

Edad en años)Razón de la visitaVisitas
<1Fiebre de origen desconocido270.000
1-17Lesión superficial, contusión1.6 millones
18–44Torceduras y esguinces3,2 millones
45–64Dolor de pecho inespecífico1.5 millones
65–84Dolor de pecho inespecífico643.000
85+Lesión superficial, contusión213.000

Independiente [ editar ]

Además de los departamentos de emergencia normales de los hospitales, se ha desarrollado una tendencia en algunos estados (incluidos Texas y Colorado) de departamentos de emergencia que no están adscritos a los hospitales. Estos nuevos departamentos de emergencia se conocen como departamentos de emergencia independientes. La razón fundamental de estas operaciones es la capacidad de operar fuera de las políticas del hospital, lo que puede generar un aumento de los tiempos de espera y una menor satisfacción del paciente.

Estos departamentos han suscitado controversias debido a la confusión de los consumidores sobre sus precios y cobertura de seguro. En 2017, el mayor operador, Adeptus Health , se declaró en quiebra. [18]

Gestión de uso excesivo y utilización [ editar ]

Los pacientes pueden visitar la sala de emergencias para casos que no son emergencias , lo que generalmente le cuesta más al paciente y a la compañía de seguros de atención administrada y, por lo tanto, la compañía de seguros puede aplicar la administración de utilización para denegar la cobertura. [19] En 2004, un estudio encontró que las visitas a la sala de emergencias eran la razón más común para apelar disputas sobre la cobertura después de recibir el servicio. [20] En 2017, Anthem amplió esta cobertura de negación de manera más amplia, provocando reacciones de política pública. [21]

Reino Unido [ editar ]

El departamento de emergencias de The Royal Infirmary of Edinburgh
Signo de A&E común en el Reino Unido.
Señal de carretera del Reino Unido a un hospital con A&E

Todos los servicios de emergencia en todo el Reino Unido son financiados y administrados públicamente por el NHS de cada país constituyente ( Inglaterra , Escocia , Gales e Irlanda del Norte ). Como ocurre con la mayoría de los otros servicios del NHS , la atención de emergencia se brinda a todos, tanto a los ciudadanos residentes como a los que no residen habitualmente en el Reino Unido, de forma gratuita en el momento en que la necesiten y sin importar su capacidad de pago.

En Inglaterra, los departamentos se dividen en tres categorías: [22]

  • Departamento de tipo 1: urgencias mayores, que proporciona un servicio de 24 horas dirigido por un consultor con instalaciones de reanimación completas
  • Type 2 department – single specialty A&E service (e.g. ophthalmology, dentistry)
  • Type 3 department – other A&E/minor injury unit/walk-in centre, treating minor injuries and illnesses

Historically, waits for assessment in A&E were very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in emergency departments that required departments in England to assess and treat patients within four hours of arrival, with referral and assessment by other departments if deemed necessary. It was expected that the patients would have physically left the department within the four hours. Present policy is that 95% of all patient cases do not "breach" this four-hour wait. The busiest departments in the UK outside London include University Hospital of Wales in Cardiff, The North Wales Regional Hospital in Wrexham, the Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth.

In July 2014, the QualityWatch research programme published in-depth analysis which tracked 41 million A&E attendances from 2010 to 2013.[23] This showed that the number of patients in a department at any one time was closely linked to waiting times, and that crowding in A&E had increased as a result of a growing and ageing population, compounded by the freezing or reduction of A&E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, despite a rise of just 3% in A&E visits, and this trend looks set to continue. Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers.

A&E services in the UK are often the focus of a great deal of media and political interest, and data on A&E performance is published weekly.[24] However, this is only one part of a complex urgent and emergency care system. Reducing A&E waiting times therefore requires a comprehensive, coordinated strategy across a range of related services.[25]

Many A&E departments are crowded and confusing. Many of those attending are understandably anxious, and some are mentally ill, and especially at night are under the influence of alcohol or other substances. Pearson Lloyd's redesign – 'A Better A&E' – is claimed to have reduced aggression against hospital staff in the departments by 50 per cent. A system of environmental signage provides location-specific information for patients. Screens provide live information about how many cases are being handled and the current status of the A&E department.[26] Waiting times for patients to be seen at A&E have been rising.[27]

Katherine Henderson, the president of the Royal College of Emergency Medicine proposed in June 2020 in the light of experience in the COVID-19 pandemic in England that patients should be expected to “call before you walk”. This model for emergency care is used in Denmark.[28] In July 2020 it was adopted at the University Hospital of Wales. Less severely ill patients are to be directed to other services and those who need to be in A&E will be given an appointment. An analysis of 515 patients who attended on 18 November 2019 found that 109 patients could have been given advice on how to treat themselves or been seen elsewhere.[29] It is to be adopted throughout England for the winter of 2020.[30]

Critical conditions handled[edit]

Cardiac arrest[edit]

Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced life support as taught in advanced life support and advanced cardiac life support courses.

Heart attack[edit]

Main article: Myocardial infarction

Patients arriving to the emergency department with a myocardial infarction (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG; aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sub lingual (under the tongue) or buccal (between cheek and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs.

An ECG that reveals ST segment elevation suggests complete blockage of one of the main coronary arteries. These patients require immediate reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolysis (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction. Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolysis if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty.

Trauma[edit]

Main article: Physical trauma

Major trauma, the term for patients with multiple injuries, often from a motor vehicle crash or a major fall, is initially handled in the Emergency Department. However, trauma is a separate (surgical) specialty from emergency medicine (which is itself a medical specialty, and has certifications in the United States from the American Board of Emergency Medicine).

Trauma is treated by a trauma team who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. Some other international training bodies have started to run similar courses based on the same principles.

The services that are provided in an emergency department can range from x-rays and the setting of broken bones to those of a full-scale trauma centre. A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour".

Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma centre. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport.

Mental illness[edit]

Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many U.S. states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. The emergency department conducts medical clearance rather than treats acute behavioral disorders. From the emergency department, patients with significant mental illness may be transferred to a psychiatric unit (in many cases involuntarily).

Asthma and COPD[edit]

Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have an urgent chest X-ray and arterial blood gases and are referred for intensive care if necessary. Noninvasive ventilation in the ED has reduced the requirement for tracheal intubation in many cases of severe exacerbations of COPD.

Special facilities, training, and equipment[edit]

An ED requires different equipment and different approaches than most other hospital divisions. Patients frequently arrive with unstable conditions, and so must be treated quickly. They may be unconscious, and information such as their medical history, allergies, and blood type may be unavailable. ED staff are trained to work quickly and effectively even with minimal information.

ED staff must also interact efficiently with pre-hospital care providers such as EMTs, paramedics, and others who are occasionally based in an ED. The pre-hospital providers may use equipment unfamiliar to the average physician, but ED physicians must be expert in using (and safely removing) specialized equipment, since devices such as military anti-shock trousers ("MAST") and traction splints require special procedures. Among other reasons, given that they must be able to handle specialized equipment, physicians can now specialize in emergency medicine, and EDs employ many such specialists.

ED staff have much in common with ambulance and fire crews, combat medics, search and rescue teams, and disaster response teams. Often, joint training and practice drills are organized to improve the coordination of this complex response system. Busy EDs exchange a great deal of equipment with ambulance crews, and both must provide for replacing, returning, or reimbursing for costly items.

Cardiac arrest and major trauma are relatively common in EDs, so defibrillators, automatic ventilation and CPR machines, and bleeding control dressings are used heavily. Survival in such cases is greatly enhanced by shortening the wait for key interventions, and in recent years some of this specialized equipment has spread to pre-hospital settings. The best-known example is defibrillators, which spread first to ambulances, then in an automatic version to police cars and fire apparatus, and most recently to public spaces such as airports, office buildings, hotels, and even shopping malls.

Because time is such an essential factor in emergency treatment, EDs typically have their own diagnostic equipment to avoid waiting for equipment installed elsewhere in the hospital. Nearly all have radiographic examination rooms staffed by dedicated Radiographer, and many now have full radiology facilities including CT scanners and ultrasonography equipment. Laboratory services may be handled on a priority basis by the hospital lab, or the ED may have its own "STAT Lab" for basic labs (blood counts, blood typing, toxicology screens, etc.) that must be returned very rapidly.

Non-emergency use[edit]

Metrics applicable to the ED can be grouped into three main categories, volume, cycle time, and patient satisfaction. Volume metrics including arrivals per hour, percentage of ED beds occupied, and age of patients are understood at a basic level at all hospitals as an indication for staffing requirements. Cycle time metrics are the mainstays of the evaluation and tracking of process efficiency and are less widespread since an active effort is needed to collect and analyze this data. Patient satisfaction metrics, already commonly collected by nursing groups, physician groups, and hospitals, are useful in demonstrating the impact of changes in patient perception of care over time. Since patient satisfaction metrics are derivative and subjective, they are less useful in primary process improvement. Health information exchanges can reduce nonurgent ED visits by supplying current data about admissions, discharges, and transfers to health plans and accountable care organizations, allowing them to shift ED use to primary care settings.[31]

In all primary care trusts there are out of hours medical consultations provided by general practitioners or nurse practitioners.

In the United States, high costs are incurred by non-emergency use of the emergency room. The National Hospital Ambulatory Medical Care Survey looked at the ten most common symptoms for which giving rise to emergency room visits (cough, sore throat, back pain, fever, headache, abdominal pain, chest pain, other pain, shortness of breath, vomiting) and made suggestions as to which would be the most cost-effective choice among virtual care, retail clinic, urgent care, or emergency room. Notably, certain complaints may also be addressed by a telephone call to a person's primary care provider.[32]

In the United States, and many other countries, hospitals are beginning to create areas in their emergency rooms for people with minor injuries. These are commonly referred 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 have been shown to significantly improve the flow of patients through a department and to reduce waiting times. Urgent care clinics are another alternative, where patients can go to receive immediate care for non-life-threatening conditions. To reduce the strain on limited ED resources, American Medical Response created a checklist that allows EMTs to identify intoxicated individuals who can be safely sent to detoxification facilities instead.[33]

Overcrowding[edit]

Emergency department overcrowding is when function of a department is hindered by an inability to treat all patients in an adequate manner. This is a common occurrence in emergency departments worldwide.[34] Overcrowding causes inadequate patient care which leads to poorer patient outcomes.[34][35] To address this problem, escalation policies are used by emergency departments when responding to an increase in demand (e.g., a sudden inflow of patients) or a reduction in capacity (e.g., a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes.[36]

Emergency department waiting times[edit]

Emergency department (ED) waiting times have a serious impact on patient mortality, morbidity with readmission in less than 30 days, length of stay, and patient satisfaction. A review of the literature bears out the logical premise that since the outcome of treatment for all diseases and injuries is time-sensitive, the sooner treatment is rendered, the better the outcome.[37][38] Various studies reported significant associations between waiting times and higher mortality and morbidity among those who survived.[39] It is clear from the literature that untimely hospital deaths and morbidity can be reduced by reductions in ED waiting times.[40]

Exit block[edit]

While a significant proportion of people attending emergency departments are discharged home after treatment, many require admission for ongoing observation or treatment, or to ensure adequate social care before discharge is possible. If people requiring admission are not able to be moved to inpatient beds swiftly, "exit block" or "access block" occurs. This often leads to crowding and impairs flow to the point that it can lead to delays in appropriate treatment for newly presenting cases ("arrival access block").[41] This phenomenon is more common in densely populated areas, and affects pediatric departments less than adults ones.[41]

Exit block can lead to delays in care both in the people awaiting inpatient beds ("boarding") and those who newly present to an exit blocked department. Various solutions have been proposed, such as changes in staffing or increasing inpatient capacity.[41]

Frequent presenters[edit]

Frequent presenters are persons who will present themselves at a hospital multiple times, usually those with complex medical requirements or with psychological issues complicating medical management.[42] These persons contribute to overcrowding and typically require more hospital resources although they do not account for a significant number of visits.[43] To help prevent inappropriate emergency department use and return visits, some hospitals offer care coordination and support services such as at-home and in-shelter transitional primary care for frequent presenters and short-term housing for homeless patients recovering after discharge.[44][45]

In the military[edit]

Emergency departments in the military benefit from the added support of enlisted personnel who are capable of performing a wide variety of tasks they have been trained for through specialized military schooling. For example, in United States Military Hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more. Often, some civilian education and/or certification will be required such as an EMT certification, in case of the need to provide care outside the base where the member is stationed. The presence of highly trained enlisted personnel in an Emergency Departments drastically reduces the workload on nurses and doctors.

Violence against health care workers[edit]

According to a survey at an urban inner-city tertiary care centre in Vancouver,[46] 57% of health care workers were physically assaulted in 1996. 73% were afraid of patients as a result of violence, almost half, 49%, hid their identities from patients, 74% had reduced job satisfaction. Over one-quarter of the respondents took days off because of violence. Of respondents no longer working in the emergency department, 67% reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies cited by those surveyed.[46]

Medication errors[edit]

Emergency Department of Dartmouth General Hospital

Medication errors are issues that lead to incorrect medication distribution or potential for patient harm.[47] As of 2014, around 3% of all hospital-related adverse effects were due to medication errors in the emergency department (ED); between 4% and 14% of medications given to patients in the ED were incorrect and children were particularly at risk.[48]

Errors can arise if the doctor prescribes the wrong medication, if the prescription intended by the doctor is not the one actually communicated to the pharmacy due to an illegibly-written prescription or misheard verbal order, if the pharmacy dispenses the wrong medication, or if the medication is then given to the wrong person.[48]

The ED is a riskier environment than other areas of the hospital due to medical practitioners not knowing the patient as well as they know longer term hospital patients, due to time pressure caused by overcrowding, and due to the emergency-driven nature of the medicine that is practiced there.[35]

See also[edit]

  • Emergency department in France
  • Acute Assessment Unit
  • Emergency medical services
  • Walk-in clinic
  • Morgue

References[edit]

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Further reading[edit]

  • Bache JB, Armitt C, Gadd C (2003). Handbook of Emergency Department Procedures. Mosby. ISBN 0-7234-3322-4.
  • Mahadevan, Swaminatha V (26 May 2005). An Introduction To Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department. Cambridge University Press. ISBN 0-521-54259-6.

External links[edit]

  • Use of emergency departments for less- or non-urgent care (Canada) (Canadian Institute for Health Information)
  • Overuse of Emergency Departments Among Insured Californians (US) (California HealthCare Foundation, October 2006)
  • ED visits (US) (National Center for Health Statistics)
  • Academic Emergency Medicine, ISSN 1069-6563, Elsvier
  • Physicians on Call: California's Patchwork Approach to Emergency Department Coverage
  • Wait Time for Treatment in Hospital Emergency Departments, 2009. Hyattsville, Md.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2012.