Background: Emergency department (ED) crowding is a major issue that may lead to poor clinical judgment, therefore, may prevent patients from receiving the appropriate care. Thus, accurate prediction of patients' admission has the potential to decrease patients' length of stay and, ultimately, prevent ED overcrowding. In this study our aim was to assess the effectiveness of the Sydney Triage Admission Risk Tool (START) in ED of King Khalid University Hospital in Riyadh (KKUH). Methods: This is a retrospective validation study to assess the effectiveness of START model in ED in KKUH in Riyadh, Saudi Arabia. The data was collected from medical records of adult patients (age ≥ 14) who visited the ED from the first to the seventh of September 2018, excluding patients with life threatening conditions, referred from other hospitals, Dead on arrival and patients presented with psychiatric or obstetrics/gynecological complaints. Analysis was done by using logistic regression and... Continue Reading

Background: To maintain patient flow despite emergency department (ED) crowding, many hospitals place patients in spaces not originally designed for the initial evaluation of patients ("hallway bed"). Such spaces have a variable degree of privacy and often lack call bells, oxygen, suction, or monitors. Little is known about how the use of hallway beds effects the quality of care, patient satisfaction, and patient safety. We sought to describe the profile of patients whose evaluation was initiated in ED "hallway beds". Methods: A retrospective chart review was conducted in a single, urban, academic ED between June 2018 and June 2019. We included all patients presenting to ED whose bed assignment was a "hallway bed". We examined patient's demographic characteristics (including insurance status, race, and ethnicity), mean LOS, mode of ED arrival, emergency severity index(ESI), and disposition. Results: A total of 13,100 patients had their ED evaluation initiated in a hallway bed.... Continue Reading

Background: Despite Lumbar Punctures (LPs) known to be a safe procedure in experts' hands, many parents fear performing it on their children; thus, refusing consent. The factors behind refusal of the parents are unclear. This study aimed to explore and assess the level of knowledge of parents towards LPs who live in Riyadh, Saudi Arabia. Methods: This is a cross-sectional quantitative study that included a sample of parents residing in Riyadh. The study was conducted using an online self-administered questionnaire that was distributed through social media during November 2019 to December 2019. The questionnaire sought parent's demographic data and questions which were divided into three main aspects, i.e. knowledge, perception, and attitude towards LP. Moreover, it was pretested and validated (Cronbach Alpha test = 0.718). The data was analyzed and compared using Chi-square test. Results: There were 1276 participants (parents, mothers and fathers, not less than 18 years of age,... Continue Reading

Background: There is comparatively little literature on the epidemiology and management of injury and illness at sea, an environment which is austere, distant from definitive medical care, and defined by highly variable but generally limited on site medical resources. Threats to life, limb, and sight carry a significant personal and economic cost in the workers in tens of thousands of ships. We sought to characterize ocular illnesses and injuries on commercial vessels. Methods: This is a retrospective chart review among adult patients evaluating the incidence and types of ocular injuries and illnesses occurring on the vessels. The charts were from a maritime telemedicine practice that provides care and medical direction to a variety of vessels worldwide. Data were extracted from October 2018 through September 2019. Charts were evaluated by emergency physicians who collected data. Results: We enrolled 803 patients,of which 31 (3.8%) were for primary ocular complaints. 32.3% were for... Continue Reading

Background: Emergency department (ED) overcrowding with non-urgent cases is a significant public health problem with several consequences, such as prolonged waiting time and delayed care for more acutely ill patients. Triage systems are established to determine the urgency of patients in the EDs. An example is the Canadian Triage and Acuity Scale (CTAS) which is a 5-category scale. Patients who are classified as CTAS 1, 2, and 3 are urgent, while CTAS 4 and 5 are non-urgent. Previous studies in Saudi Arabia show that 50-60% of ED visits are non-urgent, but did not investigate their association with mortality. Therefore, we aimed to determine the relationship between non-urgent ED visits and patients' mortality. Methods: A cross-sectional retrospective study was conducted at King Khalid National Guard Hospital in Jeddah. A convenient sample was retrieved from the BestCare database by including all ED visits which were categorized in CTAS from June 2016 to... Continue Reading

Background: The Ottawa Ankle Rules (OAR) were developed in 1992 in order to develop decision rules for the use of radiography in the emergency department (ED) and reduce unnecessary imaging. The purpose of this study is to evaluate how these OAR were applied in the ED of a university hospital between the 1st of July and the end of December of the year 2016. It examines how the OAR application in the ED has evolved compared to a similar study with data from 2015. The previous study led to changes in protocol as well as the implementation of training to improve the application of the OAR in triage. This study evaluates the success of these changes and trainings as well as whether predictive factors can be identified that drive the application of the OAR in the ED. Methods: In a retrospective cohort study, a sample of patient records aged between... Continue Reading

Background: Medication errors (MEs) and other drug related problems (DRPs) are common issues on hospital admission. These MEs and DRPs can cause preventable adverse drug events (pADEs) resulting in patient harm with a significant additional cost. The aim of this study was to determine the economic value and the cost-benefit of a clinical pharmacist CP in the ED by applying a theoretical model (University of Sheffield School of Health and Related Research – SCHARR). Methods: This retrospective, single-center, observational study was carried out in the ED of a university hospital. Since October 2016, 1 FTE CP is dedicated to the ED. Patient-specific recommendations recorded by the CP during a 1 month period were observed. On admission to the ED, the CP carried out a standardized medication reconciliation and medication review determining pADEs. The most important pADE for each patient was selected and classified for its potential to cause harm using... Continue Reading

Background: Patients leaving the emergency department (ED) without being seen (LWBS) by a physician are a worldwide known phenomenon. These patients represent 0.36 to 15% of the total number of patients visiting the ED, depending on the region and the settings of the ED. In this study we identified the prevalence and possible causes of this phenomenon in a large tertiary ED, with approximately 75000 yearly visits. Methods: Between 01 June 2018 and 30 November 2018, patients who had left the ED prematurely were contacted by phone, one week after their ED visit. A standardized questionnaire was used to conduct the phone survey. Additional information was acquired from the patient’s medical record. Results: A total of 598 out of 30127 patients (1.98%) left the ED prematurely, of which 509 (85.1%) were contacted by phone and 259 (43.4%) agreed to participate. LWBS patients were significantly younger, and the degree of emergency... Continue Reading

Background: Scorpion are abundantly found in desert environment. The aim of this study was to review the demographics of scorpion stings in the Riyadh region, the current practice of management, the utility of the laboratories investigations, and their effect on hospitalizations, length of stay in the Emergency Department (ED), and return visits. Methods: The study was a retrospective observational descriptive chart review. Data were collected from the electronic health system (BESTCare2.0A.Ink) from January 2016 to April 2019. It was a consecutive sample. We included all adult patients (> 14 years old) who presented to King Abdul-Aziz Medical City (KAMC) complaining of clinical manifestations of scorpion envenomation. Data were analyzed using kobotoolbox (kobotoolbox.org), and Excel. The t-test was used to compare ED length of stay between the different groups of patients. Results: We included 286 patients; the mean age was 34.5 (±13.8). Male patients represented (85.66%) of the sample. All the... Continue Reading

Background: The rate of return visits to the emergency department is considered an important quality of care indicator and a tool for improving the quality of care provided to ED patients as well as patient safety. The aim of this study was to determine the patterns of adult (>18 years) return visits within 48 hours to the emergency department to identify the rate of return visits to the Sultan Qaboos University Hospital ED. Methods: The medical records from Track Care system of all adult patients revisiting the ED of Sultan Qaboos University Hospital between May 2016 and October 2016 were reviewed retrospectively in terms of patient demographic information, date and time presenting to ED, chief presenting complaint, diagnoses, triage level 1-5 and final disposition. Results: The total number of return visits made by adults included in this study were 401 return visits, the remaining return visits representing pediatric visits and... Continue Reading