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Challenges and Future Trends of Emergency Medicine Healthcare System

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Dear Colleagues,

The COVID-19 pandemic has exposed the fragility of local and hospital emergency medicine healthcare systems. It is necessary to analyze this system and its critical aspects in order to rethink its structure and function, which involves the organization of territorial emergencies, triage, emergency departments, and hospitals. We need to tackle the problem of hospital crowding, which generates crowding of emergency departments, and thus worse outcomes for patients with poorer health. It must be accepted that different types of emergencies may have to be dealt with simultaneously. In this scenario, it will be necessary to design new systems to recognize and treat general acute health situations, as well as those that will become more frequent, such as often-unrecognized geriatric health problems. It will also be vital to establish optimal diagnostic and therapeutic pathways for both acute diseases and rare diseases, as even these are sometimes not recognized. Hospital wards will need to be part of this plan, adopting platforms that reduce crowding and arranging beds for acute patients. Certain categories of fragile patients deserve to have specific attention, for example, HIV patients and patients with mental illnesses and social hardships; these patients must often be urgently treated. All of this will also lead to drastic changes in the methods of teaching healthcare providers, including students, and in the design emergency departments. In these scenarios, reflections on the legal aspects of accessibility to care can serve as interesting starting points.

Dr. Gabriele Savioli
Guest Editor

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Keywords

crowding
ED designing
ED-management
management of territorial emergencies
maxi emergencies
fragile patients
rare disease emergencies
geriatric emergencies

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11 pages, 1114 KiB

Open AccessArticle

Operational Status of Isolation Rooms in Emergency Departments and Patient Concentration in Higher-Level Emergency Departments in Daegu Metropolitan City and Neighboring Provinces, South Korea, during the COVID-19 Pandemic

by Heonjoo Kim and Hansol Chung

Int. J. Environ. Res. Public Health 2023, 20(4), 3113; https://doi.org/10.3390/ijerph20043113 - 10 Feb 2023

Viewed by 932

Abstract

Background: In a pandemic situation such as the one of the COVID-19 pandemic, nosocomial transmissions attempted to be prevented by initially classifying them in triage. Therefore, emergency departments (EDs) installed isolation rooms at their entrance. Additionally, a system for pre-emptive quarantine at the triage stage was established nationwide for patients with COVID-19-related symptoms. Methods: Data were retrospectively collected from 28,609 patients who visited the regional emergency medical center of Yeungnam University Hospital in Daegu Metropolitan City in 2021. The study population was divided into experimental and control groups comprising patients with and without COVID-19-related symptoms, respectively. The difference in the percentage of patients visiting from outside the city was investigated between the two groups. The critically ill patient (CP) ratio was analyzed in the experimental group to verify the appropriateness of visiting a higher-level ED and was further divided into sub-regions to determine their reason for visiting an ED beyond their residential region. Results: Most lower-level EDs did not have isolation rooms. About 20.1% and 17.3% of patients in the experimental and control groups visited a higher-level ED with an isolation room beyond their residential region, respectively. The absence of an isolation room in the ED in their residential region was one reason for traveling beyond their residential region, with an odds ratio of 4.44 (95% confidence interval: 0.53–8.35). Conclusion: In the process of implementing the “pre-emptive quarantine” system, it was revealed that the cooperation of the lower-level EDs was not effective during the implementation of the “pre-emptive quarantine” system. Consequently, a higher number of patients with COVID-19-related symptoms had to locate an ED with an isolation room and travel a longer distance than general patients. The participation of more EDs is required. Full article

(This article belongs to the Special Issue Challenges and Future Trends of Emergency Medicine Healthcare System)

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10 pages, 900 KiB

Open AccessArticle

The FRISK (Fracture Risk)—A New Tool to Indicate the Probability of Fractures

by Florian Wichlas, Franziska Melanie Hahn, Serafeim Tsitsilonis, Tobias Lindner, Tim Marnitz, Christian Deininger and Valeska Hofmann

Int. J. Environ. Res. Public Health 2023, 20(2), 1265; https://doi.org/10.3390/ijerph20021265 - 10 Jan 2023

Viewed by 1277

Abstract

Increasing patient inflow into the emergency department makes it necessary to optimize triage management. The scope of this work was to determine simple factors that could detect fractures in patients without the need for specialized personnel. Between 2014 and 2015, 798 patients were admitted to an orthopedic emergency department and prospectively included in the study. The patients received a questionnaire before contacting the doctor. Objective and subjective data were evaluated to determine fracture risk for the upper and lower extremities. The highest risk for fractures in one region was the hip (73.21%; n = 56), followed by the wrist (60.32%; n = 63) and the femoral shaft (4 of 7, 57.14%; n = 7). The regions with the lowest risk were the knee (8.41%; n = 107), the ankle (18.29%; n = 164), and the forearm shaft (30.00%; n = 10). Age was a predictor for fracture: patients older than 59 years had a risk greater than 59.26%, and patients older than 90 years had a risk greater than 83.33%. The functional questions could exclude fractures. Three factors seem to be able to predict fracture risk: the injured region, the patient’s age, and a functional question. They can be used for a probatory heuristic that needs to be proven in a prospective way. Full article

(This article belongs to the Special Issue Challenges and Future Trends of Emergency Medicine Healthcare System)

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