| 1. |
- Davidson, Lee Ti, et al.
(författare)
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Association of physiological stress markers at the emergency department to readmission and death within 90 days: a prospective observational study
- 2023
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 128:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Predicting the risk of readmission or death in patients at the emergency department (ED) is essential in identifying patients who would benefit the most from interventions. We aimed to explore the prognostic value of mid-regional proadrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, and high-sensitivity troponin T (hs-TnT) to identify patients with a higher risk of readmission and death among patients presenting with chest pain (CP) and/or shortness of breath (SOB) in the ED.Methods: This single-center prospective observational study included non-critically ill adult patients with a chief complaint of CP and/or SOB who visited the ED at Linköping University Hospital. Baseline data and blood samples were collected, and patients were followed up for 90 days after inclusion. The primary outcome was a composite of readmission and/or death from non-traumatic causes within 90 days of inclusion. Binary logistic regression was used and receiver operating characteristics (ROC) curves were constructed to determine the prognostic performance for predicting readmission and/or death within 90 days.Results: A total of 313 patients were included and 64 (20.4%) met the primary endpoint. MR-proADM > 0.75 pmol/L (odds ratio [OR]: 2.361 [95% confidence interval [CI]: 1.031 – 5.407], P = 0.042) and multimorbidity (OR: 2.647 [95% CI: 1.282 – 5.469], P = 0.009) were significantly associated with readmission and/or death within 90 days. MR-proADM increased predictive value in the ROC analysis to age, sex, and multimorbidity (P = 0.006).Conclusions: In non-critically ill patients with CP and/or SOB in the ED, MR-proADM and multimorbidity may be helpful for the prediction of the risk of readmission and/or death within 90 days.
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| 2. |
- Rooney, Kevin D, et al.
(författare)
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Point-of-care testing in the overcrowded emergency department - can it make a difference?
- 2014
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 18:6, s. 692-
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Forskningsöversikt (refereegranskat)abstract
- Emergency departments (EDs) face several challenges in maintaining consistent quality care in the face of steadily increasing public demand. Improvements in the survival rate of critically ill patients in the ED are directly related to the advancement of early recognition and treatment. Frequent episodes of overcrowding and prolonged waiting times force EDs to operate beyond their capacity and threaten to impact upon patient care. The objectives of this review are as follows: (a) to establish overcrowding as a threat to patient outcomes, person-centered care, and public safety in the ED; (b) to describe scenarios in which point-of-care testing (POCT) has been found to ameliorate factors thought to contribute to overcrowding; and (c) to discuss how POCT can be used directly, and indirectly, to expedite patient care and improve outcomes. Various studies have shown that overcrowding in the ED has profound effects on operational efficiency and patient care. Several reports have quantified overcrowding in the ED and have described a relationship between heightened periods of overcrowding and delays in treatment, increased incidence of adverse events, and an even greater probability of mortality. In certain scenarios, POCT has been found to increase the number of patients discharged in a timely manner, expedite triage of urgent but non-emergency patients, and decrease delays to treatment initiation. This review concludes that POCT, when used effectively, may alleviate the negative impacts of overcrowding on the safety, effectiveness, and person-centeredness of care in the ED.
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| 5. |
- Schilling, Ulf Martin
(författare)
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Clinical evaluation and cross-validation of the point-of-care system istat at the emergency department versus central laboratory analysis
- 2014
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Ingår i: Point of Care. - : Lippincott Williams & Wilkins. - 1533-029X .- 1533-0303. ; 13:1, s. 24-26
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the emergency department (ED), large numbers of blood samples are taken on a daily basis. Owing to their ability to produce rapid results, point-of-care (POC) analysis systems are applied increasingly in the ED. In the current study, we cross validated the quality of the POC iSTAT (Abbott point of care) against the central laboratory for the most common blood samples taken at the ED of a tertiary care university hospital. METHODS: Forty-one patients older than 18 years presenting to the ED owing to shortness of breath or chest pain were enrolled in the study. In all patients, the following tests were performed on venous blood: iSTAT Chem8 + (sodium, Na; potassium, K; chloride, Cl; ionized Ca; glucose; serum urea nitrogen, BUN; creatinine; hematocrit; hemoglobin), and CG4 + (venous blood gas [VBG] + lactate). Similar tests were performed parallel to the central laboratory of the hospital. Troponin testing was performed but omitted for clinical consideration owing to the routine use of high-sensitivity troponin by our central laboratory. Statistical analysis was performed using the Pearson correlation coefficient on each analyte. RESULTS: The results of the POC analysis were available at a mean ± SD of 48.5 minutes earlier than the central laboratory results. The Chem8 + results between iSTAT and central laboratory correlated to a high degree, with the least correlation relating to K (κ = 0.77), Cl (κ = 0.82), and ionized Ca (κ = 0.86). All other items ranged between κ = 0.9 (Na) and κ andgt; 0.95 (glucose, BUN, creatinine, hematocrit, and hemoglobin). For the CG4 +, pH revealed a κ = 0.87, pCO2 κ = 0.9, base excess κ = 0.9, HCO3 κ = 0.72, pO2 κ = 0.62, and SpO2 (saturation) κ = 0.77. Lactate analysis showed a κ = 0.94. The results from the central analysis testing showed lower pH, base excess, and HCO3 values than the POC, whereas the pCO2 and lactate values were higher in the central laboratory. The discrepant values might have resulted in inadequate treatment in the clinical context. When an arterial blood gas was simultaneously analyzed by POC and the central laboratory (20 samples), we found the following results: HCO3 κ = 0.9, SpO2 κ = 0.93, and all other κ andgt; 0.95. CONCLUSION: The electrolyte analyses performed by the POC-system iSTAT correlate to a very high degree with the analysis provided by our central laboratory. The POC iSTAT system might be considered as a potential POC device for use in the ED. Furthermore, our findings suggest that POC might serve as independent control system for the clinician to find potential problems in the process of blood sample analysis.
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| 6. |
- Schilling, Ulf Martin
(författare)
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Cost awareness among Swedish physicians working at the emergency department.
- 2009
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - 1473-5695. ; 16:3, s. 131-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Sweden the public health system is subject of increasing budget problems. Medical training in Sweden does not yet focus on the cost aspects in patients diagnoses and treatment. STUDY OBJECTIVES: This study was carried out to survey the general knowledge among physicians working in the emergency department about the cost of the usual diagnostic tests used in ruling out pulmonary embolism. METHODS: Knowledge about costs among Swedish physicians was evaluated in the context of the emergency department of a university hospital. Thirty physicians answered an anonymous questionnaire about the costs for several items used in the diagnosis of pulmonary embolism. Answers within +/-25% of the real costs were regarded as correct. Evaluation took into consideration the physicians' specialty and experience as emergency physician, house officer or consultant in internal medicine. Statistical analysis was carried out using the Student's t-test, Kruskal-Wallis test and Mann-Whitney U test where applicable. Probability levels of less than 0.05 were accepted as significant. RESULTS: Mean deviation to the real cost was 52% with a correct estimation of an average 28%. No significant difference could be detected in this study among emergency department physicians, house officers and consultants in internal medicine regarding the cost awareness towards the items considered. CONCLUSION: Generally cost awareness was considered low among all participating doctors. The level of experience seemed not to be related to better knowledge about prices. Younger doctors generally tended to underestimate the costs of investigation. Further education will be necessary to raise the level of cost awareness among hospital doctors.
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| 7. |
- Schilling, Ulf Martin
(författare)
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Costs and the emergency department
- 2012
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Ingår i: Toward Healthcare Resource Stewardship. - : Nova Science Publishers, Inc.. - 9781621001829 ; , s. 181-202
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Schilling, Ulf Martin
(författare)
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Cutting costs : the impact of price lists on the cost development at the emergency department.
- 2010
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 17:6, s. 337-339
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Tidskriftsartikel (refereegranskat)abstract
- It was shown that physicians working at the Swedish emergency department (ED) are unaware of the costs for investigations performed. This study evaluated the possible impact of price lists on the overall laboratory and radiology costs at the ED of a Swedish university hospital. Price lists including the most common laboratory analyses and radiological investigations at the ED were created. The lists were distributed to all internal medicine physicians by e-mail and exposed above their working stations continually. No lists were provided for the orthopaedic control group. The average costs for laboratory and radiological investigations during the months of June and July 2007 and 2008 were calculated. Neither clinical nor admission procedures were changed. The physicians were blinded towards the study. Statistical analysis was performed using the Student's t-test. A total of 1442 orthopaedic and 1585 medical patients were attended to in 2007. In 2008, 1467 orthopaedic and 1637 medical patients required emergency service. The average costs per patient were 980.27 SKR (98€)/999.41 SKR (100€, +1.95%) for orthopaedic and 1081.36 SKR (108€)/877.3 SKR (88€, -18.8%) for medical patients. Laboratory costs decreased by 9% in orthopaedic and 21.4% in medical patients. Radiology costs changed +5.4% in orthopaedic and -20.59% in medical patients. The distribution and promotion of price lists as a tool at the ED to heighten cost awareness resulted in a major decrease in the investigation costs. A significant decrease in radiological costs could be observed. It can be concluded that price lists are an effective tool to cut costs in public healthcare.
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| 9. |
- Schilling, Ulf Martin, et al.
(författare)
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Drowning
- 2012
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Ingår i: Minerva Anestesiologica. - : Edizione Minerva Medica. - 0375-9393 .- 1827-1596. ; 78:1, s. 69-77
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Forskningsöversikt (refereegranskat)abstract
- Approximately 500,000 deaths due to drowning are reported annually, 30,000 of which are reported in Europe. Because of the relatively low incidence of drowning victims at emergency departments, most emergency physicians do not routinely handle drowning victims. Although confusion regarding the classification and pathophysiology of drowning could be reduced by following the Utstein style consensus, the application of therapeutic modalities and, most important, the estimation of probable prognostic outcomes remain difficult for emergency physicians. This article presents an overview of the classification, pathophysiology, emergency-department treatment and prognostic outcomes of drowning accidents.
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| 10. |
- Schilling, Ulf Martin
(författare)
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Drunkning
- 2010. - 1
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Ingår i: Akut pediatrik. - : Liber. - 9789147094028 ; , s. 349-352
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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