Original/Research Article

The Reasons of Emergency Department Patients’ Dissatisfaction

Farhad Rahmati, Hossien Gholamalipoor, Behrooz Hashemi, Mohammad Mehdi Forouzanfar, Fatemeh Hosseini

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 59-63

Introduction: Evaluating the reasons of emergency patient dissatisfaction and trying to eliminate them is a step towards increasing the quality of care and profitability. Therefore, this study aimed to evaluate the reasons of patient dissatisfaction in the emergency department of Shohadaye Tajrish Hospital, Tehran, Iran. Methods: The present cross-sectional study was done in the time interval between March 2012 and October 2014. All the patients who had declared their dissatisfaction, whether written, verbal, or by phone, were included. Using a pre-designed checklist, data were gathered regarding characteristics of dissatisfaction including: type, reference, presentation, subject, and outcome and analyzed using SPSS version 21. Significance level was considered as p<0.05. Results: 123 cases of dissatisfaction were detected. In 31 (25.2%) cases the patient was right, in 41 (33.3%) the hospital was right and 51 (41.5%) cases had no outcome. The dissatisfactions were written in 23 (18.7%) cases, by phone in 17 (13.8%), and verbal in 83 (67.5%), which showed no significant correlation with the outcome (p=0.277). Only 31 (25.2%) cases were declared by the patients themselves which had no correlation with the outcome (p=0.747). However, there was a significant correlation between the type (p=0.025) and subject (p<0.001) of dissatisfaction with the outcome. Conclusion: The results of this study showed that most cases of dissatisfaction were assigned to the surgery group and nursing service. Low quality care and bad behavior of the staff were among the most common causes of patients’ dissatisfaction. In all cases of dissatisfaction regarding the neurosurgery service, internal medicine service, and admission unit, the patients have been right. In contrast, in all cases of triage and laboratory unit, the hospital has been right.

Effects of irrigation with different solution on Incidence of Wound Infection

Majid Zamani, Fatemeh Sadeghi Panah, Mehrdad Esmailian, Reza Azizkhani, Zahra Yoosefian, Mojtaba soltani

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 64-69

Introduction: Management of acute and chronic wounds has significantly altered in the last decade but little attention has been paid to the solution used for cleansing the wounds. Therefore, the present study aimed to compare the effects of tap water, distilled water, and normal saline for wound cleansing in emergency department. Methods: This is a double-blind randomized clinical trial with a 10-day follow up. Patients who had superficial wounds were randomly divided into 3 treatment groups: normal saline, distilled water, and tap water. The wounds were cleansed using a 20 - 60 milliliter syringe with an 18 gauge needle. All the patients were discharged with the same antibiotic and were followed 48 hours and 10-day to determine the presence or absence of infection symptoms. The evaluated outcomes were infection incidence in the first 48 hours and 10 days after being discharged. Results: 1200 patients were included in the present study (57% male, average age 25.5 ± 11.0 years). 43 (3.5%) patients showed infection symptoms in the first 48 hours. Ten (2.5%) patients were in normal saline treated group, 15 (3.7%) patients were in distilled water group, and 18 (4.4%) patients were in tap water treated group (p=0.32). 13 (3.2%) patients in normal saline group, 20 (4.9%) patients in distilled water group and 23 (5.6%) in the tap water group did not take their antibiotics. Prevalence of infection were higher in patients who did not take antibiotics (p < 0.001). The 10-day follow-up revealed that all the patients were recovered and showed no infection symptoms. Conclusion: The results of the present study showed that the prevalence of infection in using the 3 agents (normal saline, distilled water and tap water) for cleansing wounds was similar. Therefore, drinking water could be considered as an alternative for cleansing wounds.

Defining Emergency Department Necessary Policies Based on Clinical Governance Accreditation Scores

Mehrdad Esmailian, Mohammad Nasr Esfahani, Ali Motallebi Nahyeh

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 70-75

Introduction: The role of accreditation scheme in quality improvement of emergency departments (ED) has not been thoroughly evaluated in studies. Therefore, this study was designed to appraise the effects of policies defined based on clinical governance accreditation scores, on improvement of the procedures in ED. Methods: The present cohort study was carried out in the ED of Alzahra University Hospital, Isfahan, Iran in 2012-2013. In 2012 the deficiencies in ED of this hospital was determined based on clinical governance indicators. Then the deficiencies were classified based on their importance and changes were made in the ED. Finally, the effects of the changes were evaluated in August 2013. Results: The evaluation made in 2012 showed that 23 clinical and non-clinical procedures were carried out with deficiencies. Over the mentioned period, 6 (26.1%) procedures were not done at all, while 17 (73.9%) were done without a policy and irregularly. The overall score for clinical and non-clinical procedures in the ED before carrying out the accreditation scheme was 43 / 230 (18.7% of the maximum possible score). The score was raised to 222 equal to 96.5% of the maximum possible score after carrying out the scheme. This increase was statistically significant (p < 0.001). Conclusion: The findings of the present study showed that defining policies for improving the procedures carried out in ED based on accreditation scheme leads to improvement of medical services in ED.

Effect of Education on Knowledge and Attitude Regarding Bioterrorism

Siavash Hamzeh pour, Nazli Khajehnasiri

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 76-81

Introduction: Bioterrorism, as a major health problem, has received lots of attention in recent years. To date, the effect of education on knowledge and attitude of students regarding bioterrorism has not been evaluated in Iran. Therefore, this study aimed to determine how education affects knowledge and attitude of biological sciences students about bioterrorism. Methods: The present interventional before-after study was carried out on the students of different branches of biological sciences. The students’ level of knowledge on nature of bioterrorism and its causatives, diagnosing bioterrorism agents, management at the time of biological and bioterrorist attacks, and tendency to participate in relief at these events were evaluated before and after training using a pre-designed checklist. Then the effect of education on the students’ knowledge and attitude was evaluated based on their sex. Results: 120 students were included (60% female; mean age 21 ± 3.2 years). The knowledge score was not significantly different between female and male students before educational intervention (p > 0.05). After education, the knowledge score raised significantly in the 4 areas of bioterrorism nature (p < 0.0001), causative factors (p < 0.0001), diagnosing bioterrorism agents (p < 0.0001), and management at the time of bioterrorist attacks (p < 0.0001) in female participants, but not in male students (p > 0.05). In addition, after education both male and female participants showed greater tendency to work and do research in the field of bioterrorism (p < 0.0001) but the increase was more significant in females (p < 0.0001). Conclusion: Educational intervention led to an improvement in female participants’ knowledge regarding bioterrorism nature, causative factors, diagnosing bioterrorism agents, and management at the time of bioterrorist attacks. Yet, the low level of knowledge and tendency of the students indicates the need for more education in this field.

The Effects of FOCUS-PDCA Methodology on Emergency Department Patient Disposition Index

Hossien Jabbari beirami, Yalda Mousazadeh, Solmaz Pourranjbari, Mohammad Asghari Jafarabadi

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 82-87

Introduction: Hospital emergency is an important and unique department and prolonged stay of the patients in this ward leads to a decrease in the ability to serve other patients in need. Therefore, this study aimed to evaluate the ability of FOCUS-PDCA methodology to decrease waiting time of the procedures and improve index of decision-making within 6 hours in emergency department (ED). Methods: In this interventional before-after study, the effect of FOCUS-PDCA methodology on waiting time of the procedures and decision-making was evaluated in the ED of Sina Hospital, Tabriz, Iran in a 5-month period. Initially, a team of procedure definers defined the problematic procedures and suggested practical solutions to relieve them. Then, these solutions were practiced using appropriate programming, and finally the effects of these measures were analyzed using SPSS version 11.5 and independent t-test. Results: 5 months after intervention, mean waiting time for receiving consultation was reduced from 28.1 to 17 minutes (p < 0.001) and mean time for the results of a laboratory test to be ready was reduced from 70.26 to 37.66 minutes (p = 0.006). The number of patients who stayed in the ED for more than 6 hours, which was 101 in April, decreased to 52 in November (p = 0.002). The index of patient disposition in less than 6 hours increased from 94.71% in April to 96.87% in November. Conclusion: Based on the results of this study, it seems that carrying out FOCUS-PDCA methodology can decrease waiting time of the procedures and improve patient disposition index in the ED. 

Letter to Editor

Outcome of Cardiac Arrest Patients Brought to Emergency Department by Private Cars

Hosein Dinpanah, Alireza Maleki Rastekenari

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 58

Although monitoring and initiating resuscitation for these patients by emergency medical services in the initial moments may be important in their final outcome, some of these patients are brought to emergency department (ED) by private cars due to lack of knowledge. This letter presents statistics in this regard and evaluates their outcome.

Brief Report

Evaluating the Quality of Multiple Trauma Patient Records in the Emergency Department of Imam Khomeini Hospital in Urmia

Gholamreza Faridaalaee, Behzad Boushehri, Neda Mohammadi, Omid Safari

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 88-92

Introduction: Medical profile is an important source of data regarding the patient, the illness, the doctor’s performance and leads to adequate diagnosis and treatment. Filling out medical profiles correctly, greatly decreases medical errors and leads to accurate diagnosis and proper treatment of the patients. This study aims to evaluate the quality of the patient records of trauma patients admitted to the emergency department of Emam Khomeini Hospital, Urmia, Iran. Methods: In a cross-sectional study, the medical profiles of trauma patients admitted to the emergency department of Emam Khomeini Hospital, Urmia, Iran in November 2013 were evaluated aiming to determine the quality of filling the profiles. All the patients’ medical profiles were evaluated regarding accurate recording of trauma mechanism; size, site of injuries; vital signs recordings; diagnostic and treatment plan. Based on the Likert scale, the quality of data recording was rated as: not recorded, recorded with high quality, recorded with low quality. The data were statistically analyzed using SPSS 21. Results: In this study, 795 profiles were studied and evaluated (66.7% male). The most accurate data recording belonged to mechanism of trauma (92.5%) and the least accurate data recording belonged to diagnostic plan (9%). The highest frequency of incomplete data belonged to the site of injuries caused by trauma (71.7%), the number of injuries (34%) and anatomical depth and severity of trauma (34%). Most cases of missing data belonged to diagnostic plan (91%). In 142 (17.8%) profiles only 1, in 241 (30.3%) profiles 2, and in 277 (34.8%) profiles 3 categories were incomplete and data recording in 135 (16.9%) profiles were incomplete in all categories. In total, 82% of the profiles had 1 or more incomplete categories. Conclusion: Based on the results of this study, the quality of data recordings of trauma patients admitted to the studied emergency department was not satisfying. The highest rate of incomplete data belonged to the site of injury caused by trauma and the highest rate of missing data belonged to diagnostic plan. 

Education in Emergency Department from the Viewpoint of Medical Students

Fatemeh Heydari, Mitra Amini, Ali Mannani, Samira Esfandiari, Mohammad Kalantari Meibodi

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 93-97

Introduction: Emergency is an important department of any hospital, and education of medical students in this ward is of great importance. The students gain necessary skills for facing critical situations in this department. Therefore, educational conditions should be constantly monitored and improved in order to reach an efficient situation. The present study was aimed to survey the interns’ viewpoint on the condition of medical education in the emergency department (ED). Methods: In this cross-sectional study, 100 interns of Shiraz University of Medical Sciences were questioned using a pre-designed checklist during the time between October 2013 and October 2014. The checklist consisted of demographic data and survey questions regarding the current condition, theoretical knowledge, practical skills, educational rank of ED compared to other hospital’s departments, and varying the duration of the educational course in ED. The data were analyzed using SPSS 21. Results: 100 interns were evaluated (55% female), with an average age of 24.7±1.5 years (minimum 23 and maximum 26). Most of the interns believed that training regarding clinical examination, diagnosis expression and treatment orders was enough for learning key points, while bedside education was inadequate. Most of the interns believed that gaining theoretical knowledge on examination and diagnosis, was acceptable except regarding encountering patients with a decreased level of consciousness. Yet, they believed there were some deficiencies regarding theoretical knowledge on treatment, except for treating allergies. Educational rank of ED compared to other departments was believed to be average. 60% of the interns thought that the duration of medical education in ED should be increased, 4% believed it should be decreased, and 36% were satisfied with the current duration. Conclusion: Based on the results of this survey, the interns of two studied Hospitals were averagely satisfied with their educational condition in ED. Most interns believed that there was deficiency in the bedside education and theoretical knowledge, while they were relatively satisfied with the amount and quality of practical skills’ training. 

120 Cases of Shoulder Dislocation referred to Emergency Department during One Year; a Case Series Study

Payman Asadi, Vahid Monsef Kasmaie, Seyyed Mahdi Zia Ziabari, Behzad Zohrevandi, Nadia sajedi

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 98-101

Shoulder dislocation is identified as displacement of humerus head from the glenoid cavity of scapula bone, which makes up about 50% of total joint dislocations. Taking into account the importance of the side effects and disabilities caused by this type of dislocation and that it can be prevented, the present study was designed aiming to evaluate the epidemiologic characteristics of the patients with shoulder dislocation. In this retrospective cross-sectional study, all the patients referred to the emergency department (ED) with complaint of shoulder dislocation throughout one year were evaluated. Demographic data and characteristics regarding the type of dislocation, presence of accompanying fractures, mechanism of dislocation, history of dislocation and the method of reduction were extracted from the patients’ profiles and recorded in a checklist designed for this purpose. Data were then statistically analyzed using SPSS version 19. Statistics showed that 120 patients with the mean age of 39.3 ± 21.2 years had been admitted to ED of the studied center in one year (79.2% male). The most common type of dislocation was anterior dislocation (95.8%) and in the right shoulder (52.5%) and the most common cause was falling on open arm (34.2%). Reduction method was non-operative in 93.3% of the cases and surgery in 6.7%. Based on the results of this study, in the studied population, most patients with shoulder dislocation were young men who had an anterior dislocation in their right shoulder because of falling on out stretched hand and treated with close reduction. 

Case Report

Early Death from Rabies Despite of Receiving Immunoglobulin and Vaccine

Mahmood Sadeghi, Masoome Bayani, Mohammad Montazeri

Iranian Journal of Emergency Medicine, Vol. 2 No. 2 (2015), , Page 102-104

Rabies is a viral disease with the high rate of mortality, which is non-curable after presenting clinical signs weather in humans or animals. Persons who are bitten by suspicious animals can be protected from rabies, in case of early referring to the health care preventive centers. However, the rate of durability and safety are questionable among those received immunoglobulin and vaccine. Here, it was reported a 57 year-old woman who was bitten by a jackal and died, despite of receiving immunoglobulin and rabies vaccine.