INTRODUCTION:Triaging patients into correct severity categories in an emergency department is an advanced skill that depends on a quick assessment after obtaining very little information. The purpose of this study was to assess specific risk factors associated with hospital admissions in the emergency department environment of the specialized Eye, Ear, Nose, and Throat hospital located in Shanghai, China.METHODS:This study was a retrospective cohort study. Patients visiting the emergency department in a tertiary hospital in eastern China from February 2008 to August 2015 were included. Univariate and multivariate analyses were used to identify the risk factors related to hospital admissions. Combining variables calculated from the regression equation of multivariate analysis (binary logistic regression analysis) enabled the risk factors quantification. The receiver operating characteristic analysis was used to identify the most informative cutoff point of the combining predictors.RESULTS:A total of 188715 patients were enrolled in the study. Of them, 8395 patients (4.4%) required hospital admission. Hour of visit, season, age, sex, chief complaint, anatomical location, and locale of patients were independent risk factors of hospital admission by univariate and multivariate analysis. Combining predictors were calculated from the equation of the multivariate logistic model. The area under the curve of the combining predictors was 0.949, and the 95% confidence interval was 0.947 to 0.951 (P <.001), with a sensitivity of 95.2% and a specificity of 85.6%. A cutoff score of less than -35.1975 was associated with hospital admission.DISCUSSION:This study provided a method to build a feasible predictive model of hospital admission during triage. Understanding risk factors is an important part of the triage process in order to correctly assign priorities to the patients served. The outcomes of this study would add additional information for the triage nurse to consider in assessing the patient and assigning acuity ratings. The model developed here requires validation in future research.

Introduction: The aim of the present study was to evaluate the demographic characteristics, exposure features, and prophylactic care aspects of cases that presented to the emergency department of 1 state hospital in Turkey between 2013 and 2017 because of the risk of rabies contact. Methods: Data from the retrospective cohort study were obtained from ED records of Erzurum Palandoken State Hospital between August 2013 and June 2017 regarding patients presenting to emergency service after the risk of rabies contact. Evaluation forms included demographic characteristics of the patients, contact type, contacted animal, exposure features, and the status of prophylaxis. Descriptive analysis, with frequency and percentage, was used. Results: A total of 691 records were analyzed. The mean age of the patients was 29.2 years (SD 1/4 0.65). Of those, 547 (79%) were male, and 144 (21%) were female. Regarding location, 506 (73%) of the 691 cases were from urban areas, and 185 (27%) from rural settings. Of the cases, 515 (74%) were bite injuries, 159 (23%) were scratches, and 22 (3%) were contact. Of the contacted animals, 483 (70%) were dogs, 171 (25%) were cats, 11 (2%) were foxes, 14 (2%) were horses, 2 (< 1%) were sheep, and 10 (1%) were cattle. A total of 16 animals were vaccinated, however the vaccination status of 675 cases were not known by the patients. Discussion: It would be beneficial to increase the number of studies regarding animal control, make correct and complete mandatory reporting, properly maintain the risky contact record, and create better pet vaccination cards in Turkey. The training deficiencies of related personnel at risk for contact with rabies are a major public health problem.

I read with great interest the article in JEN about the Portuguese emergency medical care system.1Padilha JM Coimbra N The Portuguese emergency medical system.J Emerg Nurs. 2015; 41: 255-259Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar I was particularly interested in this article because I had occasion to witness use of this emergency medical care system last year while on a cruise of the Douro River.One of the gentlemen we were traveling with had experienced health problems upon arrival in Portugal from Los Angeles and spent 2 days in the ICU in Lisboa (Lisbon). Nevertheless, the physicians cleared him to continue his vacation, which included a bus tour to the north of the country and a 6-day river cruise into Spain and back. On the second day of the cruise, while we were eating dinner together, he excused himself from the table and left the dining room. A few minutes later one of the crew members came and got his wife, and one of our friends who went with her came back to tell us “they were trying to resuscitate him”!I immediately left my seat and went to see if I could help. The boat crew was extremely well trained in CPR and in using the automatic external defibrillator, which was talking to them in Portuguese, of course! I assisted with some breathing, but it seemed obvious to me that this patient was probably dead when he went down. The crew told me, “the doctors are coming.” We were docked at the time but literally in the middle of a very rural setting. About 30 minutes out the paramedics arrived.The article says that the paramedics always include a nurse. No one identified himself or herself as either a nurse or a doctor, but again, they were very professional and obviously well trained. They continued CPR for a few more minutes before pronouncing that he had died.Of interest is the situation that followed. Portugal has no facilities for embalming because their culture is “die today, bury tomorrow.” The widow was willing to have her husband cremated, but the son, back in Los Angeles, vetoed that option because his father was Jewish and would have wanted a regular burial. I am not sure how it was accomplished, but with the help of the American Embassy, the body finally arrived home 3 weeks later. My latest information is that a death certificate is still pending (which is holding up filing for insurance, etc.) because the usual process is to issue the certificate 1 year after the death!From what I observed I would feel quite comfortable with emergency care in Portugal. I read with great interest the article in JEN about the Portuguese emergency medical care system.1Padilha JM Coimbra N The Portuguese emergency medical system.J Emerg Nurs. 2015; 41: 255-259Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar I was particularly interested in this article because I had occasion to witness use of this emergency medical care system last year while on a cruise of the Douro River. One of the gentlemen we were traveling with had experienced health problems upon arrival in Portugal from Los Angeles and spent 2 days in the ICU in Lisboa (Lisbon). Nevertheless, the physicians cleared him to continue his vacation, which included a bus tour to the north of the country and a 6-day river cruise into Spain and back. On the second day of the cruise, while we were eating dinner together, he excused himself from the table and left the dining room. A few minutes later one of the crew members came and got his wife, and one of our friends who went with her came back to tell us “they were trying to resuscitate him”! I immediately left my seat and went to see if I could help. The boat crew was extremely well trained in CPR and in using the automatic external defibrillator, which was talking to them in Portuguese, of course! I assisted with some breathing, but it seemed obvious to me that this patient was probably dead when he went down. The crew told me, “the doctors are coming.” We were docked at the time but literally in the middle of a very rural setting. About 30 minutes out the paramedics arrived. The article says that the paramedics always include a nurse. No one identified himself or herself as either a nurse or a doctor, but again, they were very professional and obviously well trained. They continued CPR for a few more minutes before pronouncing that he had died. Of interest is the situation that followed. Portugal has no facilities for embalming because their culture is “die today, bury tomorrow.” The widow was willing to have her husband cremated, but the son, back in Los Angeles, vetoed that option because his father was Jewish and would have wanted a regular burial. I am not sure how it was accomplished, but with the help of the American Embassy, the body finally arrived home 3 weeks later. My latest information is that a death certificate is still pending (which is holding up filing for insurance, etc.) because the usual process is to issue the certificate 1 year after the death! From what I observed I would feel quite comfortable with emergency care in Portugal. The Portuguese Emergency Medical SystemJournal of Emergency NursingVol. 41Issue 3PreviewPortugal, which was founded in 1143, is a small southwest European country with a total of 35,556.15 square miles (roughly the size of the state of Maine in the United States). It consists of a continental portion that shares a land border with Spain and a maritime border with the Atlantic Ocean, along with 2 archipelagos: the Azores and Madeira. Portugal has been a member of the European Community since 1985 and has a population of approximately 10,562,178 inhabitants (52.2% female and 47.8% male). Full-Text PDF Response from JEN International Nursing Section Co-EditorJournal of Emergency NursingVol. 41Issue 5PreviewFirst of all, my condolences to you and the family of the gentleman who died while on this vacation. It is certainly not what anyone thinks about when planning a trip or traveling. May good memories sustain everyone during their time of grieving. Full-Text PDF Response from AuthorsJournal of Emergency NursingVol. 41Issue 5PreviewWe offer our condolences for your loss and appreciate the recognition of the preparation and operation of the Portuguese emergency medical system that works even in very rural areas that are difficult to access. Full-Text PDF

First of all, my condolences to you and the family of the gentleman who died while on this vacation. It is certainly not what anyone thinks about when planning a trip or traveling. May good memories sustain everyone during their time of grieving. We are grateful that you felt that the care provided, both on shore and on the cruise ship, was well handled. In the midst of such a crisis, it is somewhat comforting to know that the best available care was provided by everyone involved. It is interesting to know that our colleagues in emergency care, no matter where they live, all have the same desires to provide the highest quality of care to their patients. Although some countries have differing health care systems, they have educational processes in place just like we do in our own country, and patients receiving emergency care truly are treated similarly. Thank you for taking the time to write this letter to remind us all that we are indeed part of a much larger family of international caregivers, whether on land or at sea. Emergency situations can happen anywhere at any time, and as a cruise ship nurse myself, I am pleased that the crew on the ship was able to respond to the emergency as well. I thank our authors for bringing us great information regarding emergency care in their country. Article about Portuguese Emergency CareJournal of Emergency NursingVol. 41Issue 5PreviewI read with great interest the article in JEN about the Portuguese emergency medical care system.1 I was particularly interested in this article because I had occasion to witness use of this emergency medical care system last year while on a cruise of the Douro River. Full-Text PDF

It didn't seem like the years were passing by that quickly. In what seemed to be the flash of an eye, I discovered that a friend from the past, an emergency nurse and former ENA member, had died after an illness. Fond memories came back to me. O'Neta Barr, RN, was by my side during many of the early years of Missouri ENA's Ozark Chapter; she was a dedicated member and president of the Missouri State Council. Ironically, the end of O'Neta's emergency nursing career began during a return trip from a State Council meeting in Kansas City, when 4 of us were involved in a major motor vehicle crash. Sliding on the rainy pavement, our car careened through the darkness, past the stop sign, and sideswiped an oncoming vehicle. Our car spun and came to a stop in the middle of the road. As we extricated ourselves from the car, another vehicle crested the hill, and there was a second impact. I screamed O'Neta's name and jumped out of the way, with only seconds to spare. O'Neta was under the front passenger wheel. I knelt beside her and she began to run down her injuries: “Pat, I've got a femur and a tib/fib. I'm breathing ok.” The ambulance arrived. I started her intravenous line, applied oxygen, and helped with splinting while a flight nurse colleague radioed for our home helicopter. We all had cared for so many trauma victims. Now, we were those victims. Despite complications, O'Neta courageously rallied back to a semblance of health and returned to emergency nursing, her love, but only for a short while. Sadly, we lost one of the greatest emergency nurses and mentors in our specialty. Anyone who worked with her felt her aura of strength, and others drew that strength from her. Before her death, we learned that O'Neta had requested that a contribution be made to the educational fund of the Ozark Chapter of ENA in lieu of flowers, even though it had been many years since our paths had crossed. Although O'Neta never became a nationally known figure in the world of emergency nursing, the impact she made through her bedside care, her continual teaching and mentoring of colleagues, and her work on the state level will not be forgotten. A member of the Governor's Board, O'Neta was instrumental in staffing all ambulances in Missouri with emergency personnel. She taught many classes at the Red Cross and was a team member of the AAA Ambulance Service in its early days. Like emergency nurses everywhere, O'Neta fought the good fight in the trenches and won many of those battles. On behalf of emergency nurses in Missouri, thank you, O'Neta, for being a mentor to all of us whose lives you touched as you practiced your profession and lived your life with purpose, compassion, and dignity. Thank you, too, on behalf of all the patients you cared for and all the loved ones you hugged as they faced their crises. Thank you for your passion for emergency nursing and for igniting that passion in others. May God bless you and keep you in His arms forever.I knelt beside her and she began to run down her injuries: “Pat, I've got a femur and a tib/fib. I'm breathing ok.”Later in life.View Large Image Figure ViewerDownload (PPT) Pat Clutter, Ozark Chapter, is Staff Nurse/Educator.

Stifling heat outside. Ceiling fans circulating the hot air inside. Children wandering the aisles or sleeping under tables. A stray dog in the registration area and roosters crowing outside. In a setting very different from that of an educational conference in the United States, 70 Bolivian village health care providers politely sat in straight-back chairs, listened attentively, and asked pertinent questions, for 9 hours. They were attendees at the First Annual Health Care Providers Seminar in Caranavi, Bolivia, held July 21, 2003. The seminar was a joint effort of Project Helping Hands (PHH) (a United States–based health care mission organization), missionaries associated with Cup of Cold Water Ministries in Bolivia, and hospital administration and health care professionals from the Caranavi Hospital. It involved volunteers from both Bolivia and the United States.

A unique program has been developed to encourage retention of nurses who prefer to remain in direct patient care roles. Both recognition and monetary reward are available to nurses who join the "Professional Excellence in Nursing" (PEN) program. The underlying philosophy is that stable employment, clearly defined and attainable goals and recognition for a higher level of performance are keys to job satisfaction--and thus to retention. Evaluative data on this young program are not available but informal surveys indicate a positive outcome.