Asle Soleimani H, Alamdari Sh, Alaeddini F, Shahrami A ,
Volume 60, Issue 6 (9-2002)
Abstract
Introduction: Inter-hospital transport constitutes one of the important parts of the emergency system in every country.
Materials and methods: To determine the outcome of requested CCU beds from the medical emergency headquarters in year 2000 by the hospitals affiliated to Tehran university of medical sciences, we have reviewed retrospectively 2688 clinical files of patients for whom a request for an empty CCU bed in other hospitals had been sent to the medical emergency headquarters. The main measure was the success rate of being admitted to CCU in other hospitals.
Results: On the whole 68.5 percent of requests were followed by a CCU admission to other hospitals. Using logistic regression method, variables including season of the year, shift diagnosis of the patient and the original hospital were shown to be related with the success rate. Conclusion: Increasing the number of available CCU beds and providing the centers with the necessary equipment is of high priority in hospitals located in city of Tehran.
Alavi E, Pilehvari Z, Bahrami M,
Volume 66, Issue 3 (6-2008)
Abstract
Background: Aeromedical transport provides immediate advanced medical treatment for certain critically ill and injured patients, bringing about rapid treatment and decreasing the time of hospitalization. With the great expense of helicopter emergency medical services (HEMS), research and review of experience is conducted to determine areas in which the enforcement of standards will enable the effective and optimal use of HEMS.
Methods: We examined peer-reviewed published articles in French, English and Persian journals and medical texts to determine the best use of, and standards for, HEMS.
Results: We found that HEMS effectively improves health care in three categories of services: the rapid transportation of medical personnel/equipment to an accident and of patients to the hospital (primary response) meeting road ambulances at an intermediate point coming from a hospital or accident to transport patients to a hospital (secondary response) the planned urgent inter-hospital transfers of critically ill patients for specialized care (tertiary response). HEMS standards have been set for: the flight equipment and crew, the types of emergencies to which HEMS should respond, the optimal length of time for each part of the mission (call out time, response time, on-scene time, transport time, and total rescue time) and the affect on patient survival. Some other standards include: algorithms for patient screening, flight heights for different diseases and injuries, rooftop and parking garage helipad at hospital, approach of flight paths and the facility at the touchdown area. HEMS standard medical equipment includes those needed for telemedicine and basic and advanced life support. Standard drugs on board the HEMS vehicle depends on the type of the missions selected for HEMS. The area of medical crew members, as well as their fundamental and the continuing training, also has standards that must be met. The standard scoring system for severity of injury, and finally, the standard method for the annual calculation of the cost and benefit of using HEMS in a specified region have also been considered.
Conclusion: As trauma is a common reason for requesting HEMS in Iran, the decrease in "Golden Hour" response time for trauma patients is a priority. HEMS is expensive and enforcing standards also requires increased effort and expense. Nevertheless, both can reduce the morbidity, mortality and expense for longer hospital stays. Thus, the proper telemedicine and life support equipment and drugs, as well as algorithms for patient screening can improve HEMS efficacy. Furthermore, enforcing proper communication and record keeping regarding trauma severity for HEMS missions allows hospitals to predict the proper immediate treatment for incoming patients and its future need for HEMS services.
Ali Labaf , Rasoul Masoomi , Misaq Raeisi ,
Volume 73, Issue 8 (11-2015)
Abstract
Background: There is a concern by some doctors that not interrupting the patients' initial statements of concerns can lead to too long medical visits. Therefore, in this study, the duration of the patients' initial statements of concerns was studied. Methods: This descriptive cross sectional study was conducted from August to October, 2011 in the Emergency Department of Imam Khomeini Hospital in Tehran. 100 patients entered the study through convenience sampling. Based on a 5 level triage system Emergency Severity Index (ESI), patients who were not life-threatening conditions (level 5) entered the study and critically ill patients and foreign patients were excluded from the study. Demographic data of the patients and durations the patients' initial statements of concerns were recorded and measured. Results: Fifty-six percent of patients were men. 79 percent of them had academic degree less than diploma and most of them have Persian ethnicity (60 percent). The mean age of the participants was 37.09 (SD, 1.68). The mean durations of patients' initial statements was 71.60±2.37 seconds. The minimum time was 22.51 seconds and the maximum time was 206.51 seconds. There was significant difference between age (P=0.001, r=0.382) and gender (P=0.032, df=98, t= -2.17) with the durations of patients' initial statements. But education level (P=0.996, F (2, 97)=0.004) and ethnicity (P=0.266, F (6, 93)=1.3) did not have a significant effect on the durations of patients' initial statements. Conclusion: According to the findings of this study, duration of patients' initial statements of concerns is less than what which leads to an increase the time of medical visits.
Razieh Yousefi , Payam Sasannejad, Eisa Nazar, Ali Hadianfar, Mohammad Taghi Shakeri., Zahra Jafari ,
Volume 81, Issue 11 (1-2024)
Abstract
Background: Identifying factors that influence the length of hospital stay for suspected stroke patients is crucial for optimizing the utilization of hospital resources. This study aimed to determine the factors associated with the length of hospital stay for suspected stroke patients transferred to Qaem Hospital in Mashhad through emergency services using survival analysis.
Methods: In this historical cohort study, general information was gathered for all suspected stroke patients who sought emergency services in Mashhad, the largest city in northeast Iran, from March 21, 2018, to March 20, 2019, and were then transferred to the Emergency Department of Qaem Hospital. Pre-hospital emergency data were integrated with hospital records using the mission ID. The primary outcome assessed in the study was the length of hospital stay, with model implementation carried out using the statistical software Stata.
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Results: The median hospitalization time until patients' recovery was seven days. Out of the 578 participants, 386 cases (66.8%) recovered, while the remaining 190 cases (33.2%) were censored (83 individuals had died during the study, and 107 individuals had exited the hospital for other reasons). The average age of patients at the time of hospitalization was 71.13±13.01 years. Statistical analysis employing Log-rank and Breslow tests identified a significant difference in hospitalization duration among patients receiving various levels of care and based on their insurance status. During multivariate analysis, the Cox regression model was considered unsuitable due to some variables not meeting the proportional hazards assumption, leading to the utilization of AFT models. Following the evaluation of AFT models, including Log-normal, Log-logistic, Exponential, and Weibull, the log-normal model emerged as the most suitable choice, exhibiting AIC and BIC values of 1273.909 and 1356.740, respectively. Significant variables influencing length of stay included patient admission priority, insurance status, season, and residency status.
Conclusion: The study suggests that parametric survival models are effective for analyzing lifetime data. Additionally, in light of the significant variables identified, enhancing facility readiness and resource allocation could facilitate more efficient planning and implementation.
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Hamidreza Mehryar, Mohammad Rafiei,
Volume 81, Issue 12 (2-2024)
Abstract
Background: Overcrowding in the emergency department is considered as a problem of the public health system, and the present study was conducted with the aim of evaluating the overcrowding in the emergency department of Imam Khomeini Hospital in Urmia based on the EDWIN index.
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Methods: This descriptive-analytical study was carried out cross-sectionally from March 21, 2019 to March 19, 2020, using a simple random sampling method in patients referred to the emergency department of Imam Khomeini Hospital in Urmia. Which was used to collect information from the demographic information checklist and the EDWIN index was calculated. Then the information was entered into SPSS18 software and analyzed with the help of descriptive and analytical statistics.
Results: In this study, the results showed that in terms of the frequency of triage level, 5.4% was level one, 65.6% was level two, 26.3% was level three, 2.7% was level four and there was no disease in level five. In terms of shift, 22.5% visited the hospital in the morning shift, 27.6% in the evening shift and 49.9% in the night shift. The average EDWIN index was 2.7±0.75 on holidays and 5.9±4.6 on non-holiday days. Although emergency room congestion was more on non-holiday days, this difference was not statistically significant (P=0.15). Also, the average of EDWIN in the morning shift was 2.5±2.3, in the evening shift it was 0.71±2.16 and in the night shift it was 9.7±5.8 and even though the average of EDWIN in the night shift was higher than in the evening and night shifts, this difference was not statistically significant (P=0.06).
Conclusion: The results of the present study indicated that on most of the investigated days, the emergency room was evaluated as crowded based on the EDWIN criteria. Also, there is no significant difference between the busyness of the emergency room according to the holiday or working day, as well as the morning, evening and night shift.
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