[show abstract][hide abstract] ABSTRACT: Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included.
All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission.
In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH < 7.35) and 7% had alkalosis (pH > 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission.
Despite challenges of data registration, we succeeded in creating a database of adequate size and data quality. Future studies will focus on the association between patient status at admission and patient outcome, e.g. admission to Intensive Care Unit or in-hospital mortality.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2012; 20:29. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2012; 20:28. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Systematic process triage is a relatively unknown concept in Denmark. Currently there are no national recommendations regarding triage models for use in the emergency department (ED). Four medium-sized EDs from different regions across the country cooperated in a joint venture to develop a new triage model, Danish Emergency Process Triage (DEPT). DEPT is inspired by the Swedish ADAPT system, but modified for a Danish context. This paper summarizes the cumulated experience with the new system.
[show abstract][hide abstract] ABSTRACT: Inter-hospital transportation poses potential risks to staff and patients. The present guidelines recommend competency-based management dictated by the patient's clinical condition and medical requirements during transfer. The guidelines aim to: 1) improve patient and staff safety during transport, 2) minimize the occurrence of adverse events during transport, 3) ensure that accompanying staff are trained for and skilled in transfer and retrieval medicine and 4) encourage optimal utilisation of available competencies without unnecessarily draining hospital resources.
[show abstract][hide abstract] ABSTRACT: Prompt and correct triage to a facility capable of providing optimal care is important for survival and functional outcome after major trauma. This study compared the influence of on-scene deployment of physicians with medical telephone counselling of paramedics on the triage of trauma patients.
A retrospective study of trauma patients triaged to tertiary treatment outside Frederiksborg County from March 2006 to February 2007. Patients were either triaged directly from the scene of the accident or secondarily transferred from a local hospital. The study period was divided into two intervals. Triage in the first interval was based on telephone counselling of paramedics by consultant anaesthesiologists. Triage in the second interval was performed by the same anaesthesiologists deployed in the field. Triage decisions, Injury Severity Score (ISS) and 30-day mortality were registered.
Among 607 patients, 82 were triaged to tertiary treatment. The proportion of patients triaged directly from the scene of the accident increased from 27.8% to 69.6% after prehospital deployment of physicians, whereas secondary transfers decreased from 72.2% to 30.4% (p = 0.0002). Patients triaged directly from the scene had a significantly lower ISS than secondarily transferred patients (5 (1-17) versus 17 (14-26), p < 0.0001).
Prehospital, physician-based triage of trauma significantly reduced the need for secondary transfers to tertiary facilities.
[show abstract][hide abstract] ABSTRACT: The new ERC guidelines on resuscitation emphasize the importance of quality CPR. BLS should be started as early as possible. Lay rescuers should not check for a pulse, they should call for help and start chest compressions immediately. Compression depth should be 4-5 cm at a rate of 100 compressions per minute. Chest compressions and ventilation should be performed in a ratio of 30:2. Lay rescuers should continue until professional help arrives. Lay rescuers may use the same procedure for children as recommended for adults. Professionals should, however, initiate CPR in children with 5 ventilations followed by a compression-ventilation ratio of 15:2. Automatic External Defibrillation should be used as early as possible.
[show abstract][hide abstract] ABSTRACT: Transvenous, transthoracic, and percussion pacing are well recognised treatments of bradycardia and asystole with residual p wave activity. We report two cases of severe bradycardia in which percussion pacing was applied and the procedure was found to be effective. This technique can be life-saving and it should be well-known by all doctors.