We assessed the pediatric emergency care system of our hospital. A total of about 11,714 children were carried into the emergency room during 1998. Their age was young, 33.6% being less than 4 years old and 54.5% less than 7 years old. About half a number of them (50.8%) were received between 5 p.m. and midnight and 75.3% at night. They came to our hospital from two or three secondary medical care areas, the population of which was estimated at 800,000 including 120,000 children. Twenty-six percent of outpatients and 43% of inpatients were those who had first visited the emergency unit. During the year 110 persons entered into our pediatric ICU, 45 persons underwent mechanical ventilation therapy, and an average of 7.4 patients stayed in hospital per day.We also reviewed the changes of the pediatric emergency care system of our hospital for 20 years. This system has gradually developed. Chronologically, the neonatal intensive care unit was set up in 1983, followed by the opening of the pediatric intensive care unit in 1986, the start of the 24-hour emergency medical care by pediatricians in 1993, the home mechanical ventilation therapy in 1996 and the respite care since 1997. In other words, our system developed from intensive care to primary care and home care—from in-hospital to out-hospital. These changes were the result of our effort to cope with regional features and meet demands : increase of younger children, insufficiency of pediatricians, expansion of medical area in our change and parents’ request for rediatrician’s examination at any time.In summary, an increasing number of patients who need pediatric emergency care tend to concentrate into one central hospital in a large region. Pediatric emergency care developed into general pediatric medicine including primary care and intensive care and home care.
Hospitals ; Emergency Care ; Pediatric ; seconds ; Child

Emergency Service, Hospital ; Intensive Care Units ; Outcome Assessment, Health Care

Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.
Crowding ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Patient Care ; Point-of-Care Testing ; Primary Health Care ; Rivers ; Triage

Pediatric patients (younger than 19 years) account for approximately 25% of all emergency patients. Pediatric patients have large proportions of toddlers (aged 1–5 years), low severity, illness (rather than injury), and after-hours visits. Considering these features, the authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, suggest the establishment of the pediatric certified emergency center (PCEC) to stratify Korean pediatric emergency medical system according to the Korean Acuity and Triage Scale (KTAS). The PCEC is a facility dedicated to the emergency care for a large population of KTAS 3–4 patients (i.e., mildly ill). In addition, the PCEC may perform early stabilization and transfer to the pediatric emergency centers for pediatric patients having KTAS 1–2 illnesses and injuries. To facilitate the application of emergency centers for the PCEC, the designation criteria should be flexible in terms of manpower, facility, and equipment. Financial support from the government is essential for sustainable PCEC.
After-Hours Care ; Child ; Emergencies* ; Emergency Medical Services* ; Emergency Medicine ; Emergency Service, Hospital ; Financial Support ; Humans ; Triage

PURPOSE: As emergency ultrasound (EUS) can improve the management of emergency department patients, education in EUS has become an essential part of emergency medicine resident training. This study examined the efficacy of pediatric EUS education for resident physicians 6 months after training. METHODS: A survey was conducted on emergency medicine resident physicians who participated in the Pediatric Emergency Ultrasound Course in November 2014, which is a training program of pediatric EUS generated by Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. The instructor checked the list to evaluate attendee after the course. After the course, resident physicians have been encouraged to use EUS at the patient's bedside, and the same list was checked 6 months after the course. At the same time, a survey of the number of experience of EUS during the 6 months was performed. RESULTS: Ten emergency resident physicians of Seoul National University of Hospital participated in the course and all attendees were re-evaluated 6 months after the course. The mean initial score immediately after the course and that at the 6 months follow-up was 28.6±3.13 and 20.8±3.79, respectively (p < 0.05). No significant relationship was observed between the difference score and the EUS experience number, including the observations of the other physician's EUS (p=0.603) and hands-on by themselves (p=0.771). CONCLUSION: Although a EUS education program could improve the resident physician's ability, the effect decreased with time. Hence, the resident physician's EUS ability cannot be maintained via simple emergency department duty. Therefore, the education program should be repeated regularly.
Critical Care ; Education* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Seoul ; Ultrasonography*

PURPOSE: In this research, a definition of overcrowding in emergency department (ED) was proposed, and the actual state of overcrowding in ED was measured by surveys and extensive statistical analysis of data using objective variables. METHODS: The emergency physicians (EP) of 10 arbitrarily selected hospitals were questioned about the definition and cause of overcrowding in ED. The hospitals were divided into two groups (high-feeling and low-feeling) in accordance with the survey results. Admission/discharge records of the patients including arrival/departure date and time, were also collected for the duration of 4 weeks with consideration of seasonal variations, from March 2002 to March 2003. Four parameters, the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), which were used for the evaluation of overcrowding, were calculated for each hospital. A statistical analysis was carried out to see whether any difference existed in the BR, the PR, the AR and the DV between weekends and weekdays. Also, a similar statistical method was used to analyze the differences between the high-feeling group and the low feeling group. RESULTS: In the survey, 83 physicians were asked to answer the questions. The most preferred answers (>70%) for the definition of overcrowding were "saturation of the beds in the ED for more than 6 hours a day."For the cause of overcrowding, the popular answers were "delay in the consultation and the disposition decision" (74.7%), "use of the ED by non-urgent patients"(74.7%), and "lack of inhospital beds"(65.1%). Among the 10 hospitals, 5 hospitals were categorized the high-feeling group, and the rest fell into the low-feeling group. The average BR and AR were higher in high-feeling group than those of low-feeling group (p<0.01, p<0.01). However, average PR of low-feeling group was higher than that of high-feeling group (p<0.01). Average DV did not exhibit any difference between the two groups (p=0.31). CONCLUSION: The definition of overcrowding in the ED should include not only the lack of beds in the ED but also patient's acuity and the lack of providers. Certain aspects of overcrowding are clearly different between the high-feeling and the low-feeling groups.
Crowding ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Seasons ; Tertiary Care Centers*

PURPOSE: Until recently, three variants of benign paroxysmal positional vertigo (BPPV) have been recognized: the first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. However, the last two types of BPPV have not been introduced into the textbook of Emergency Medicine yet. The otolith repositioning maneuvers are effective treatments for BPPV, but in emergency medicine, there has been little interest in and research on them. Our goals were to determine the efficacies of these treatments and to examine the clinical features of each types of BPPV. METHODS: We performed a 6-month prospective study on forty-one patients (47 cases) who presented with a history and physical examination consistent with active BPPV to the emergency departments of a secondary hospital and a tertiary hospital (Dec. 2001-May. 2002). The patients were treated with a modified Epley canalith repositioning maneuver for posterior-canal BPPV, a modified Barbecue rotation for horizontal-canal canalolithiasis, and the maneuver of Jo et al. for horizontal-canal cupulolithiasis. RESULTS: A resolution attributable to the first intervention was obtained in 71.4% of the posterior-canal BPPV cases by using the modified Epley maneuver and in 73.1% of the horizontal-canal BPPV cases by using a modified Barbecue rotation and the maneuver of Jo et al. CONCLUSION: The otolith repositioning maneuvers result in a resolution of vertigo in the majority of patients (84.8% of the cases) immediately after treatment. They are safe and require no special equipment or investigations. They should be established as the treatments of choice for BPPV in emergency department.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Otolithic Membrane* ; Physical Examination ; Prospective Studies ; Tertiary Care Centers ; Vertigo*

No abstract available.
Ambulatory Care ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Humans ; Outpatients* ; Pyelonephritis*

PURPOSE: This concept analysis identified attributes and defined triage competency among emergency nurses.METHOD: Walker and Avant's approach was used to guide the concept analysis. A literature review was completed including 26 studies, 5 reports of related associations, and 5 books.RESULTS: The concept of triage competency in emergency nurses was identified as five attributes: clinical judgment, expert assessment, management of medical resources, timely decision, and communication. Antecedents of the concept were triage education and emergency room experience. The consequences of the concept were efficiency of care, patient rating, and safety. Triage competency in emergency nurses was defined as the comprehensive ability to prioritize patients' urgency and allocate limited medical resources.CONCLUSION: This study is meaningful since it clarified triage competency among emergency nurses. The attributes and empirical indicators of this study will likely lay the foundation for development of triage competency metrics.
Clinical Competence ; Education ; Emergencies ; Emergency Nursing ; Emergency Service, Hospital ; Judgment ; Methods ; Patient Care ; Triage ; Walkers

PURPOSE: This study was done to identify essential nursing diagnoses using NANDA and their related factors and defining characteristics of patients who were cared in an emergency room. METHODS: The research checklist developed by the researcher consisted of 44 nursing diagnoses with defining characteristics and related factors and was applied to 235 patients who were admitted to an emergency room from November 1 to December 31, 2012. RESULTS: Forty-one of forty-four nursing diagnoses were identified. The most frequent nursing diagnoses were acute pain, risk for falls, and activity intolerance. The most frequent defining characteristic for the nursing diagnosis of 'acute pain' was verbal report of pain. The agreement rate with NANDA (2009)'s defining characteristics was 66.7%. CONCLUSION: Results indicate that identification of essential nursing diagnoses and their defining characteristics and related/risk factors is important for emergency patient nursing care to facilitate use of NANDA taxonomy in the emergency nursing practice and documentation systems.
Acute Pain ; Checklist ; Classification* ; Emergencies ; Emergency Nursing ; Emergency Service, Hospital* ; Humans ; Nursing Care ; Nursing Diagnosis*