Increasing impact of mental health presentations on New South Wales public hospital emerg…

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Emergency department patient preferences for waiting for a bed.

Emerg Med Australas. 2009 Feb;21(1):25-30

Authors: Bartlett S, Fatovich DM

OBJECTIVE: Many EDs have difficulty transferring admitted patients to inpatient beds in a timely manner because of access block. We assessed ED patient preferences for waiting location. METHOD: Admitted ED patients at Royal Perth Hospital, Perth, Western Australia, Australia were surveyed over a 4 week period. Patients were questioned about their preferences for waiting location (ED cubicle, ED corridor, ward corridor, no preference). Patients were also asked what they felt was the maximum acceptable time for waiting for a ward bed. We also assessed if patient expectations were met with regards to their waiting times. RESULTS: A total of 400 patients were surveyed. Of all, 121 patients (30.2%) had no preference for waiting location and 215 patients (53.8%) preferred ED cubicles. If the waiting location option was between EDs and ward corridors, 185 patients (46.2%) had no preference. Of the 215 patients who had a preference, 72.1% preferred to wait in a ward corridor (95% CI 65.5-77.8%) and 27.9% preferred the ED corridor (95% CI 22.1-34.5%). Fifty-seven per cent of patients expected to get to their ward bed within 6 h. Seventy-two point one per cent (95% CI 66.3%-77.2%) of patients did not have their expectations met for bed waiting times. CONCLUSIONS: Patients would prefer to wait in ward corridors for their ward bed if there was no ED cubicle available. Waiting in the ED corridor is their least preferred option. Patients usually expect to get to their ward bed within 3 h. However, with high levels of access block, patient expectations for waiting times for a bed are usually not met. These findings could be used to drive system changes that are more patient-focussed.

PMID: 19254309 [PubMed - indexed for MEDLINE]

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Review article: lack of effect of opiates in the treatment of acute cardiogenic pulmonary oedema.

Emerg Med Australas. 2008 Oct;20(5):384-90

Authors: Sosnowski MA

Opiates have traditionally been used as one of the main treatments of acute heart failure and are still recognized as such. Most current textbooks and official guidelines advise the use of morphine as one of the first-line treatments for patients in acute cardiogenic pulmonary oedema and a majority of physicians accept it to be the case. The author performed an extensive literature search in order to validate the evidence for the use of opiates in this condition. A total of seven papers, six in English and one in Polish, were found that directly investigated or reported the clinically important outcomes of treatment of acute pulmonary oedema. Only five of these dealt specifically with the effects of administration of opiates in acute cardiogenic pulmonary oedema. None of the above publications suggested a clinically significant improvement in outcomes of patients treated with morphine, although early research did suggest reduced anxiety, blood pressure and pulse rate as well as a reduction in arterial oxygen contents. The more recent studies suggest a strong association between increased mortality and morbidity (e.g. intensive care unit admissions or intubation rates), although causality is difficult to establish because of research methodologies. The current evidence does not support the routine use of opiates in the treatment of acute pulmonary oedema.

PMID: 18973635 [PubMed - indexed for MEDLINE]

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