Volume 6, Issue 4, 2025
Original Research
- Bridging the Gap Towards Developing Emergency Medicine: ED-based and -trained Attendings Outperform Attendings from Hospital Departments Rotating in the ED
Introduction: In Greece, Emergency Departments (EDs) are currently staffed with medical personnel without formal training in Emergency Medicine (EM). These attendings come from various medical specialty training backgrounds. The aim of the study was how ED-based attendings who have been trained in the ED for more than a year, can handle medical emergency cases compared to attendings from other medical department in terms of ED length of stay (ED-LOS).
Methods: This is a retrospective observational study. We examined the “waiting time “(Time between ED arrival/triage and Time first seen by a Physician?) and the duration between when patients were first cared for in the ED by a physician until the decision to admit or discharge (“Care Time”) (Time between Seen by physician AND Disposition). We recorded time periods from 18 different days from the EMR dataset. The study was conducted in a large ED in Athens, Greece, with 120,000 ED visits per year. We enrolled 5572 medical patients who visited the ED. The IBM SPSS v.27.0 statistic program was used for statistical analysis.
Results: The total “waiting time” of patients was 164.1±255.9 min and the “care time” of patients was 41.3±74.1 min. The ED-based attendings had significantly less patient waiting time (126.4±264.7 vs. 199.1±243.2, p=0.008) and fewer patients were waiting to be seen (2.1±1.9 vs. 4.6±4.1, p=0.001) than attendings from other medical department rotating in the ED. The ED-based attendings had significantly less time investigating and treating patients in the ED than the attendings from other medical departments (37.3±76.8 vs. 45.6±70.9, p=0.048).
Conclusion: Our study confirms that EM training can improve the quality of care, by decreasing waiting time, workup and management time in the ED. Greater benefits should be expected as Greece develops formal EM residency training.
- Characteristics of High Utilizer Patients in the Emergency Department at a University Hospital in the Kingdom of Bahrain
Background: Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits. Objective: This study aims at measuring the prevalence of this phenomenon and better understanding the characteristics of high utilizers.
Methods: A retrospective review was conducted in a tertiary care teaching hospital, for patients aged 14 years and above during the year 2022. The definition of a high utilizer is set as any patient that fits the inclusion criteria with four or more visits to the ED during 1 year.
Results: The prevalence of high utilizers in our ED is 3.9%, accounting for 12.1% of visits in 2022, where 135 was the highest number of visits made by one patient. Visits mostly consisted of level 3, Yellow (48.9%) and level 4, Green (42.8%) triage. The top three chief complaints were sore throat (16.8%), unwell adult (15.1%), and abdominal pain (12.8%). The total length of stay was 3.6 ± 3.2 h in the ED. Time of arrival was observed; 23.9% presented at night, 37.8% in the morning, and 38.8% in the evening. Conclusions: The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.
Conclusions: The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.
Other
- High Level Disinfection at Bedside? High Level Disinfection Wipes for Ultrasound Probes in the ED
A 26-year-old woman presents with a oneday history of lower abdominal cramping. She reports a positive home pregnancy test, with her last menstrual period occurring six weeks ago. On examination, she is hemodynamically stable but has mild tenderness in the suprapubic region. You perform a bedside transvaginal ultrasound confirming a 6-week intrauterine pregnancy with an appropriate fetal heart rate and no adnexal masses. After reassuring her, you arrange follow-up with the on-call OB/GYN and discharge her within 90 minutes of her arrival. As you hand the transvaginal ultrasound probe to the ED technician, they ask for guidance on how to properly clean it.
Typically, probes used on the skin surface are cleaned after each use by removing visible contamination, followed by disinfection with a lowlevel disinfectant (LLD). LLDs, which are often alcohol- or quaternary ammonium compoundbased, are applied via spray or wipes.
However, internal probes, such as those used for transvaginal imaging, are more prone to contamination, even when probe covers and LLDs are used. One study reported a condom breakage rate of up to 13% during transvaginal examinations. Another study found bacterial contamination rates of 33.7% after sheath removal, which decreased to 12.9% after LLD cleaning. Similarly, viral contamination rates were 19.4% after sheath removal and dropped to 1.0% following LLD cleaning. Due to the significant risk of crosscontamination, current guidelines recommend highlevel disinfection (HLD) for ultrasound transducers after internal use.
Traditional HLD systems often utilize chemical solutions like glutaraldehyde or hydrogen peroxide and require a separate device for cleaning. However, in 2023, the FDA approved an HLD solution in a wipe form, which is now available in the U.S. as an alternative to machine-based HLD platforms. These wipes have been approved and used in Europe since 2008.