Journal Reviews
Journal Reviews
Sokolove PE, Lee BS, Krawczyk JA, et al. Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis. Ann Emerg Med 2000; 35:327-336.
A screening protocol used at triage was only moderately effective for isolating ED patients with pulmonary tuberculosis, according to this study from Harbor/University of California at Los Angeles Medical Center. A triage nurse screened 10,674 patients, with these results: 2,218 of the screened patients were isolated at triage and underwent chest radiography; 378 were kept in isolation in the ED; and 59% of those were ultimately admitted to the hospital.
The protocol detected only 17 (63%) of 27 visits made by patients with unsuspected pulmonary tuberculosis, which was a disappointing result for the researchers. Although the tool was less sensitive than they expected, the protocol did result in the isolation of one patient a week on average with otherwise unsuspected pulmonary tuberculosis.
However, a significant percentage of patients with active pulmonary tuberculosis escaped detection and were not initially isolated at ED triage, they say, explaining that two factors are linked to the lower than expected sensitivity of the triage screening instrument:
• Some patients with active pulmonary tuberculosis deny risk factors and symptoms, which reflects the inability to obtain a reliable history during initial triage.
• A significant number of patients aren’t systematically screened by nursing personnel, even when this is the standard within the department. "This failure to achieve universal screening reflects the unpredictable nature of the ED environment," the researchers write.
In the hectic ED environment, nurses may turn their attention to an obviously ill patient and fail to screen an apparently low-risk patient, they say. They recommend further research to evaluate screening protocols and the cost-effectiveness of triage screening.
Duffy MM, Snyder K. Can ED patients read your patient education materials? J Emerg Nurs 1999; 25:294-297.
Literacy levels of adult ED patients may be too low for written discharge instructions handed out in the ED, says a study from the Medical University of South Carolina Medical Center in Charleston. In a six-month period, 110 adult patients were given a test to pinpoint their reading grade levels. The goal was to determine whether the ED patient’s literacy levels were equal to or higher than the reading grade levels of patient education materials in the ED. Here are the results:
• Of 110 patients sampled, 29 patients read at a sixth-grade level or lower.
• Although 73% had completed high school, only 50% of those tested could read at a high school level.
• 20% could read at a seventh- to eighth-grade level, 9% could read at a fourth- to sixth-grade level, 10% could read at a third-grade level or below, and 9% could not read at all.
The researchers offer the following solutions:
• Evaluate the reading levels of both your patient population and ED education materials periodically. The Rapid Estimate of Literacy in Medicine screening tool can be administered in one to two minutes by nurses to determine reading levels of patients. Computerized programs are available that scan booklets or articles to determine reading levels.
• Reinforce written material by the use of patient education videos.
• Display patient education materials so patients can select the ones they want.
• When writing instructions, use short, common nontechnical words such as "pills" instead of "medication," "eat" instead of "consume," and "make" instead of "produce."
• If a specialized word such as a medical term is necessary, include a glossary.
• Sentences should be kept to no more than eight or 10 words in length.
Lahn M, Gallagher EJ, Li SF, et al. Prospective confirmation of low arrest rates among intoxicated drivers in motor vehicle crashes. Acad Emerg Med 2000; 7:260-263.
Only one in five intoxicated drivers involved in a motor vehicle crash are arrested, says this study from the department of emergency medicine at Albert Einstein College of Medicine in Bronx, NY. Of 294 drivers brought to the ED after motor vehicle crashes, 270 had ethanol levels, with 18 meeting the study’s three criteria for "optimum likelihood for legal intervention": police at the scene, obvious inebriation, laboratory confirmation of driving while intoxicated.
Of those individuals, only 22% (4) were arrested for driving while intoxicated, which shows that the vast majority of intoxicated drivers involved in motor vehicle crashes escape detection by law enforcement officials. The researchers note that several states have legally sanctioned or mandated physician reporting of patients who drove while intoxicated. The finding gives support to that practice, they say.
"Although the ethical questions raised by such a proposal are daunting, the public health problem of [driving while intoxicated] is at least equally formidable," the researchers say.
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