S French

Doctor at triage - effect on waiting time and patient satisfaction in a Jamaican hospital.

INTRODUCTION Waiting time in the Emergency Departments is a major source of patient dissatisfaction in hospitals. Triage attempts to have the most critically ill patients seen first with an overall reduction in waiting time. Triage teams may include specially trained nurses or alternatively a specialist physician. The aim of this study was to determine if inclusion of a specialist physician on the triage team at the University Hospital of the West Indies (UHWI) in Kingston Jamaica reduced waiting time and improved patient satisfaction. METHODS A prospective, cross sectional survey of ambulatory care patients was undertaken in 2006. Triage was completed by a team consisting of a doctor and two nurses during the first week and by nurses only during the second week. RESULTS The study showed that there was no significant difference in the length of time patients spent in the emergency department based on whether or not they were triaged by a physician led team or by a team of nurses only. Type of triage team did not affect the level of patient satisfaction. Waiting time was significantly influenced by factors which came into play after triage such as the wait for X-ray and laboratory services. CONCLUSIONS There appears to be no reduction in waiting times experienced by patients at the UHWI emergency department as a result of inclusion of a specialist emergency physician in the triage process. This suggests that specialist emergency department nurses are adequately trained in triage, and that delays in the triage process at UHWI are due to other factors.

Association between exposure/non-exposure to the mandatory seat belt law with regards to compliance in vehicle accident victims: a hospital review

OBJECTIVE Injuries sustained in motor vehicle accidents (MVAs) are a major challenge to the Jamaican healthcare system. In November 1999, Jamaica enacted legislation to make seat belt usage in motor vehicles compulsory. The effect of this policy change on seat belt usage is unclear. This study therefore sought to determine the prevalence of seat belt usage and to determine the association between exposure/non-exposure to the mandatory seat belt law and seat belt use in subjects who presented to the Accident and Emergency Department (A&E) of the University Hospital of the West Indies (UHWI) as a result of motor vehicle accidents. METHODS Subjects were recruited from June to November 2003, post-seat belt law (POBL) period, and May to October 1999, pre-seat belt law (PRBL) period. Data collected included demographic variables, seat belt use and position of the occupants in the vehicle. RESULTS Of the 277 patients who were eligible for inclusion, data were complete in 258 subjects, 87 in the PRBL period and 171 in the POBL period. The prevalence of seat belt use was 47% (PRBL) and 63% (POBL) respectively. There was no significant gender difference at each period. The odds of wearing seat belt in the rear of a motor vehicle were significantly lower than that of a driver (Table 3, OR 0.19, 95% CI 0.07, 0.48). Adjusting for age, gender and position in vehicle exposure, there was about 100% increase in the odds of seat belt use during the post seat belt law era (OR = 2.09, 95% CI 1.21, 3.61). CONCLUSION It is concluded from this hospital-based study that the mandatory seat belt law legislature was associated with increased seat belt use in motor vehicle accident victims. However, current data from the Road Traffic Agency indicate that there is still an alarming number of fatalities. This clearly suggests that additional public health measures are needed to address the epidemic of motor vehicle trauma in Jamaica.

EMS response to an airliner crash

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol. While multiple errors can occur during a mass-casualty event, these can be reduced by frequent simulation exercises during which various personnel practice and learn designated roles. Efficient triage, proper communication, and knowledge of the roles are important in ensuring the best possible outcome. While the triage system and response of the EMS personnel were effective for this magnitude of catastrophe, more work is needed in order to meet predetermined standards. Ways in which this can be overcome include: (1) hosting more disaster simulation exercises; (2) encouraging more involvement with first responders; and (3) strengthening the links in the local EMS system. Vigorous public education must be instituted and maintained.

Penetrating neck trauma and the aberrant subclavian artery

Vascular injuries from penetrating trauma to the base of the neck are accompanied by significant morbidity and potential mortality. These injuries require several diagnostic adjuncts in order to facilitate early diagnosis and appropriate treatment. Herein reported is the case of a patient who sustained penetrating injury to the thoracic inlet but had a fortuitous anomaly that prevented vascular injury and its attendant complications.

The effect of hurricane Ivan on emergency department operations at the University Hospital of the West Indies

The objective of this study was to determine the impact of Hurricane Ivan on the operations of the Emergency Department (ED) at the University Hospital of the West Indies (UHWI). Hurricane Ivan,--a category four Hurricane--traversed the south coast of the island of Jamaica on September 10, 2004, causing damage to several parishes. The study design is a descriptive retrospective record-based incidence study of all admissions to the ED commencing at 8:00 am September 10, 2004 and ending at 12 midnight September 11, 2004, covering the period of the entire duration of the hurricane as well as immediately after. Injuries that took place during the hurricane, inclusive of gun-shot wounds (GSWs) represented 40% of the total patients seen. The types of admission are listed categorically as well as specific items to be considered in planning for potential disasters of higher magnitude. Overall, the coping mechanism of the ED at UHWI was adequate for this magnitude of disaster.

Evaluation of waiting times and sonographic findings in patients with first trimester vaginal bleeding at the university hospital of the west indies. Can emergency department ultrasound make a difference

BACKGROUND Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department. OBJECTIVE This retrospective study was conducted to evaluate how long patients wait for a pelvic ultrasound. We also sought to establish how many patients had ultrasound findings that would have allowed safe discharge home. METHODS The records of 150 patients seen in the six-month period from January 1 to July 30, 2008 were examined. Data were extracted pertaining to age, time to see an emergency room doctor, time taken for ultrasound examination to be obtained from the radiology department and the ultrasound findings. RESULT Fifty-four per cent presented to the Emergency Department with a complaint of vaginal bleeding and abdominal pain, 29% with bleeding only, 16% with abdominal pain only and one with syncope. One hundred and sixteen of the patients enrolled had an ultrasound performed at UHWI. The average waiting time for an ultrasound was 3.8 ± 2.5 hours. The majority (66/116) of the patients had an intrauterine pregnancy (IUP) demonstrated on ultrasound. Twenty-nine had no IUP, free fluid or adnexal mass. These 95 patients would likely have been discharged home. Ten patients had an adnexal mass with or without free fluid, and ten had free fluid only on ultrasound. One patient was found to have a definite ectopic pregnancy. These 21 patients would have been referred for evaluation by the obstetrician on call for further management. CONCLUSION The majority of patients had sonographic findings that would have allowed safe and timely discharge from the Emergency Department had ultrasound been available at the point of care.