Emergency Care Journal

Triage nurse staffing: a study on the need for model improvements

Arian Zaboli — 2024-11-08

This study addresses the challenge of determining appropriate nurse staffing levels for triage in Emergency Departments (EDs). It evaluates whether existing nurse staffing models, typically designed for other hospital settings, can be effectively applied to triage. The research was conducted at Merano Hospital’s ED from January 1, 2021, to November 30, 2022, and involved an analysis of data from patient triage assessments. The findings indicate that standard ward staffing models are not easily adaptable to the triage environment, underscoring the need for a more systematic approach to calculating triage nurse staffing. The current Italian ministerial guidelines do not account for the unique demands and complexities of the triage setting.

Optimizing ambulance nurse performance in southern Tuscany: insights from a Delphi study

Christian Ramacciani Isemann — 2024-11-06

This study aims to enhance the performance of ambulance nurses in Southern Tuscany through a Delphi method analysis. Conducted from January to December 2022, the research engaged 16 expert participants from a Tuscan health agency. Data on 89 interventions performed by "India" ambulances, which are nurse-led emergency vehicles, were collected. The Delphi method facilitated structured communication among the experts over three rounds, resulting in consensus on nine key intervention proposals. These proposals span areas including staff training, measurement and data collection methods, technologies and materials, and work environments. Key recommendations include prioritizing high-fidelity simulation training, improving data collection for clinical risk, and standardizing equipment across all emergency units. The study highlights the importance of continuous professional development, technological integration, and supportive work environments to optimize the effectiveness of pre-hospital emergency care. These findings provide a practical roadmap for enhancing the competencies and performance of ambulance nurses, ultimately improving patient outcomes in emergency situations.

No evidence of "weekend effect" for complications of medical and surgical care

Camilla Mattiuzzi — 2024-10-15

We performed an electronic search in CDC WONDER online database (years 2018-2022) to explore whether the higher risk of dying during the weekends may be related to complications of medical and surgical care. One-way ANOVA and Tukey's HSD multiple comparison test revealed no significant variation in mean number of deaths during the seven days of the week in the US. No significant difference was observed between the mean number of deaths during the weekend and those recorded during the weekdays (675±130 vs. 711±112; p=0.339). The mean ratio of mortality due to complications of medical and surgical care to the total number of deaths was not significantly different on weekends and weekdays (151 vs. 158×100,000 deaths; p=0.255). The results of this analysis suggest that the so-called “weekend effect” may not be apparently attributable to complications of medical and surgical care and may hence be more related to patient-specific factors.

Bridging language barriers by implementing a translated-based triage scale manual into the mother tongue language: a tool for strengthening emergency care

Sofia-Chrysovalantou Zagalioti — 2024-09-26

Dear Editor,

Emergency Medicine (EM) is a promising novel specialization in Greece. EM is a young but fast-developing field that should benefit by adopting and incorporating elements from countries where the specialization is already well-established. The first and most crucial stage in every overcrowded Emergency Department (ED) is triage, namely the process by which patients are categorized according to their clinical severity. In a recent study, we aimed to evaluate the effect of triage training of Emergency Nurses (ENs) in the use of the Swiss Triage System (STS) manual translated into Greek, after an intervention of one week. [...]

Management of fever and associated symptoms in children and adults: an Italian national survey

Antonio Chiaretti — 2024-11-08

An advisory committee of Italian experts conducted a national, cross-sectional, web-based survey in June 2024 to describe the current management of fever and associated symptoms in different settings, including primary care, emergency departments, and hospital wards in pediatric and adult patients. The survey covered two domains: participants’ features and questions about the main drugs prescribed to treat fever and associated symptoms. A total of 832 questionnaires were analyzed. Paracetamol was the most prescribed drug to treat fever. Most participants were influenced by related symptoms when choosing the most appropriate drug. Almost all participants selected the oral route as their preferred one. This survey provides a current state of fever management among physicians in different settings throughout Italy. It highlights a trend in treating fever with antipyretics at appropriate doses and evaluating pain through validated scales.

An unusual malposition of the nasogastric tube in the pleural space: a case report

Dino Eminente — 2024-09-26

Nasogastric Tubes (NGT) are widely used in hospitals, e.g. for the administration of nutrients or drugs and gastric release after major surgeries. Blind insertion of these tubes is usually performed by nurses, residents, and other health care providers. In this case report, we present an incident of misplacement of the NGT, located in the pleural space, and causing pneumothorax. NGT can be inserted accidentally into the airways leading to complications like pneumonia, pneumothorax, and even death. Mechanically ventilated patients are at high risk of having an NGT misplaced, since they often have reduced consciousness and weak cough reflex.