Editorial
Jana Šeblová
Contents
Emergency Departments in the Czech Republic – Ministry of Health of the Czech Republic 2015
Our experience with paediatric triage at the Pediatric Emergency Department in Bratislava, Slovakia
Marcel Brenner
Abstract
Proper assessment of the patient’s condition is crucial for determining follow-up. Departments with 24/7/365 emergency services represent the place where at one point there are patients coming themselves from a place of its natural habitat, are brought to hospital by emergency medical service (after the evaluation of health conditions) or they come by personal or public transport. Within the responsible approach is necessary to know or/and review the state of health of all those patients who are waiting for medical treatment in the workplace. Waiting time is sometimes longer than the actual examination and treatment. Specifying degree of urgency correctly and planning appropriate method of treatment must be provided using reliable and verifiable manner. Triage system using a scoring system PEWS (Pediatric Early Warning System) has been used at Peadiatric Emergency Department (OUP) since 2012.
Emergency Department of University Hospital Hradec Králové
Jaromír Kočí, David Tuček
Urgentní příjem Nemocnice Jindřichův Hradec a.s.
Vít Lorenc
Central and Emergency Department in Kladno Regional Hospital
Renata Poláková, Štěpánka Burešová, Richard Brzezny
History and Medical Organisation of the Emergency department of the University Hospital of Leuven
Caroline Siau, Philippe Dewolf, Marc Sabbe
Abstract
The Emergency Department of the University Hospital of Leuven was founded in 1972, initially as a reception area. However, the evolution went fast to a full academic ED. It currently is a semi-open system. Within the organisation of the ED, we distinguish the out-of-hospital activities and the in-hospital department (dispatch, triage, boxes and clinical observational units and intern resuscitation team). The tasks of an Emergency Physician are initial assessment, stabilisation of patients, in-hospital resuscitation, interhospital transport and crisis management.
Emergency Department of Johannes Kepler University Linz
Ctibor Vojta, Walter Mitterndorfer, Jan Mach
Paediatric Emergency Deaptrment of Motol University Hospital
Jitka Dissou
Emergency Department of Motol University Hospital
Jiří Zika
Emergency Department of Olomouc University Hospital
Petr Hubáček
Abstract
Emergency department has been opened in 2005 as a new department for admitting emergency patients to the University Hospital Olomouc. Within ten years, there has been a full development and the department is adapted for taking care of patients with sudden onset of the disease or trauma, regardless of the traditional division of medical disciplines and the seriousness of health disorders. Centralization of acute care at University Hospital was completed. The department is also the base for postgraduate training in emergency specializations including emergency medicine and disaster medicine. Olomouc ED is the first in the Czech Republic which guarantees and provides education in obligatory subject Emergency Medicine at the Medical Faculty of Palacky University in Olomouc. ED is a crisis management center in University Hospital Olomouc.
Department of Central Admission of the University Hospital Ostrava
Stanislav Jelen, Jiří Bílek, Kamila Moslerová
Abstract
Department of Central Admission of the University Hospital Ostrava provides services for the admission of planned, acute, as well as emergency patients; it operates for 24 hours a day, seven days a week. The Department is further responsible for providing treatment for outpatients with suddenly occurring illnesses or injuries, in order to ensure the continuity of pre-hospital and hospital care, including the triage and admission of patients during large-scale incidents. Annually, the Department provides treatment for the average of 52 000 patients. The operational costs of the Department reach tens of millions Czech crowns every year.
Emergency of Military University Hospital Prague
Pavel Kupka
Emergency Department of Masaryk Hospital in Ústí nad Labem
Jana Bednářová
Admission through Resuscitation Deaprtment in University Hospital Královské Vinohrady
Michal Fric
Summary of presented Emergency Departments
Urgentní medicína a urgentní příjmy v České republice
Jana Šeblovác
Urgentní medicína a urgentní příjmy – management poptávky versus poskytování akutní péče
Agnes Meulemans
Summary of presented Emergency Departments
Pediatric Emergency Department in Bratislava
This department is a separate paediatric ED of the Paediatric University Hospital in Bratislava. It was founded in 2009. The department has both outpatient and inpatient sections, and on average 3800 patients are treated per month. In 2014, over 51 000 patients were cared for. Paediatric care, paediatric surgery and emergency medicine are the specialties covered. The basic triage is beween surgical and non-surgical divisions. Triage takes place according to Paediatric Early Warning System (PEWS) in an triage area. 15-20% of arriving patients are hospitalized.
Emergency Department of University Hospital Hradec Králové
The clinical work of the ED was initiated in 2008. Currently, the department cares for all acute patients, including patients triaged to the level of supraspecialised care. The Emergency Severity index, version 4 with 5 grades of severity, has been used for triage since 2010. This has been approved by an accreditation commitee, too. In 2014 the department surpassed treshold of 46 000 patients and the number of triage positive traumatological and cerebrovascular patients are also rising. The department acts as an effective filter for the hospital with only 13% of arriving patients being hospitalized. One third of those are admitted to the ICU. The department is also an educational site for the emergency medicine specialty and guarantee and provider of Advanced Trauma Life Support (ATLS) courses in the Czech Republic.
Emergency Department in Jindřichův Hradec Hospital
This sole ED in the Southern Bohemian region was launched in April 2014 and its initiation required organizational changes in the functioning of other hospital departments. The ED works closely with Emergency Medical Service of the Southern Bohemian Region, whose medical as well as non-medical personnel takes part in the EDs functioning. The department tends to all acute patetients regardless of severity or character of impairment with the exception of paediatric patiens (who are taken care of in a pediatric clinic) and labours. In one year since its opening 21 000 patients were treated.
Central and Emergency Department in Kladno Regional Hospital
This ED has been opened in 2011 after the construction of a new center for acute medicine in Kladno Regional Hospital. It has a central admission department with several outpatient rooms providing specialized medical care. Further, it has an emergency department for patients in danger of or with compromised vital functions and immobilized patients. The ED treats on average 6530 patients per year, and if taken together with the central admission department over 71000 patients are cared for. From 2014 onwards triage is carried out according to 3 stage ESI scale. 65% of patients arriving to the ED are hospitalized, 30% are released and the remaining 5% are transfered to higher level care. Kladno Regional Hospital is a certified stroke unit. Excellent regional collaboration between emergency medical service, ED and neurological ICU lead to not only increasing numbers of administered thrombolysis for acute stroke patients but mainly to shortening of door-to-needle time from 60 to 36 minutes during the last three years.
Emergency department of the University Hospital of Leuven
The Emergency Department of the University Hospital of Leuven was founded in1972, initially as a reception area. However, the evolution went fast to a full academic ED.
It currently is a semi-open system. Within the organization of the ED, we distinguish the out-of-hospital activities and the in-hospital department (dispatch, triage, boxes and clinical observational units and intern resuscitation team).
The tasks of an Emergency Physician are initial assessment, stabilization of patients, in-hospital resuscitation, interhospital transport and crisis management.
Emergency Department of Johannes Kepler University Linz
A reception ambulance has been in operation since opening of the hospital itself, however a separate place for admission of patients has been founded when an EMS system has been established in 1974. Currently, the emergency department is designed as a multidisciplinary unit divided into two sections – traumatological and medical one. In both sections there are operation rooms designated for the most critical patients who are treated by personnel from the anaesthesiological-resuscitation clinic. Modernization of the emergency department is planned for the near future and the ED will become a separate and independent unit.
Paediatric Emergency Department of Motol University Hospital
This is the only paediatric emergency department in the Czech Republic. It was founded in 2009, however it picked up the thread of activity of pediatric admission unit (1979) and inpatient observational unit (1981). In last two years, over 30 000 patients per year were treated, with 5000 children arriving at the ED. The ED is a part of paediatric traumacenter and is responsible for disaster prepardness of the hospitals‘ pediatric section. At this ED, patients can be observed up to maximum of 8 hours. The activity and organization of care are continuously in development due to international collaborations and implementation of external experiences.
Emergency Department of Motol University Hospital
The emergency department in the Motol University Hospital is one of the oldest ones and was originally operated by Emergency Medical Service of the Capital Prague. From its origin until April of this year the department has been designed as non-traumatological, however from May 2015 this has been changed after substantial reconstruction and re-organization and both medical and trauma patiens are cared for. In its current form, the ED has a reception, triage, medical, traumatological, surgical and general outpatient wards and inpatient section with 17 beds in seven rooms, including four beds for critical care. One of those rooms has a separate entry with filter and pressure air-conditioning and is designated for treatment of patients with highly virulent infections. The workplace is certified for postgraduate education of emergency medicine and under an EU grant also delivered pregraduate education for the Second medical faculty of the Charles University. Residents of all specialties who are training at the University Hospital also intern at the ED.
Emergency Department of Olomouc University Hospital
Emergency department has been opened in 2005 as a new department for admitting emergency patients to the University Hospital Olomouc. Within ten years, there has been a full development and the department is adapted for taking care of patients with sudden onset of a disease or trauma, regardless of the traditional division of medical disciplines and the seriousness of health disorders. Thus, centralization of acute care at University Hospital was completed. The department is also a base for postgraduate training in emergency specializations including emergency and disaster medicine. Olomouc ED is the first in the Czech Republic which guarantees and provides education in obligatory subject Emergency Medicine at the Medical Faculty of Palacky University in Olomouc. ED is a crisis management center in University Hospital Olomouc.
Department of Central Admission of the University Hospital Ostrava
Department of Central Admission of the University Hospital Ostrava provides services for the admission of planned, acute, as well as emergency patients; it operates for 24 hours a day, seven days a week. The department is further responsible for providing treatment for outpatients with suddenly occurring illnesses or injuries, in order to ensure the continuity of pre-hospital and hospital care, including the triage and admission of patients during large-scale incidents. Annually, the department provides treatment for an average of 52 000 patients. The operational costs of the department reach tens of millions Czech crowns every year.
Emergency of Military University Hospital Prague
he emergency department of the Military University Hospital in Prague is one of the first EDs in the Czech Republic and its creation in 1997 has been inspired by and consolidated knowledge from international peace mission, allied NATO forces and trainings in Israel. Currently, it has an emergency department, unit with observational beds for patients in danger of or with compromised vital functions and ambulance for traumatological and acute care for those with sudden changes in medical conditions. A four stage modified ESI scale is used for triage. The ED is a part of traumacenter, complex cerebrovascular care center and cardiological center. In case of a mass casualty incidents or disasters, the center abides by hospitals‘ traumatological plan and coordinates care. Further, the ED is an admission point for all soldiers from the Armed Forces of the Czech Republic repatriated due to medical reasons and for patients from MEDEVAC program. It is also a certified training site for emergency medicine.
Emergency Department of Masaryk Hospital in Ústí nad Labem
ED in the Masaryk Hospital in Ústí nad Labem functions as an independent ward from 2008. In its current form it has excellent continuity of care with access to diagnostic tools, operating rooms and intensive care beds. Beyond reception, it has ED section with specialized outpatient rooms (internal care, neurological, urological, traumatological, surgical and general one), and a unit with observational beds with complete monitoring. The ED is ready for mass casualty and disaster incidents with regards to methodological approaches, apparatus, and materials. From 2012 it is a certified training site for emergency medicine specialty.
Admission through Resuscitation Department in University Hospital Královské Vinohrady
Due to a pavillion character of University Hospital Kralovske Vinohrady, the hospital does not have a typical emergency department and admission of patients is divided among several clinics. The admission point, described here, receives patients from EMS who are in danger of or with compromised vital functions and is part of an anesthesiological and resuscitation clinic. The unit is equipped for multimodal monitoring of all vital functions and for artificial pulmonary ventilation. The unit has a bed-side RTG and USG, CT and operating room are in vicinity and immediately accessible. In case of activation of traumatological plan, the capacity can be increased by four acute beds for emergency care. Continuty of care is provided by a resuscitation ward with ten beds.