Background:Workplace violence (WPV) is a serious issue worldwide. Violence against emergency department (ED) staffs causes significant physical and mental distress which affects work productivity and patient care.Objective:We seek amount and type of WPV perceived by the emergency physicians and nurses, their reporting agencies, and impact of violence on them.Methods:It was a cross-sectional study conducted at a tertiary health care center. Data were collected based on 24-item questionnaire between January and December 2017. Descriptive statistics was used to describe characteristics of participants and exposure to violence. Chi-square and Fisher's exact tests were used for bivariate analysis while logistic regression analysis was to analyze the impact of violence with participant characteristics. P < 0.05 was used to judge the clinical significance.Results:Two hundred and thirty-five participants (123 doctors and 112 nurses) completed the survey. About 67% of the participants (158/235) reported verbal abuse (VA), physical assault (PA) was reported by 17% (40/235), while confrontation was reported by 11% (27/235). Family members were the main perpetrator for VA (75%) and PA (35%). Regarding reporting, the violent incidences were mostly reported to ED security and ED faculty. Individuals with comparatively less age group, less experience, and male gender were more exposed to abuse both VA and PA at P < 0.05. Nurses and junior residents reported more abuse than senior residents (P < 0.05). Majority of the participants had reported lack of job satisfaction due to Verbal abuse (P = 0.01).Conclusion:WPV is common in ED of the current setting. It results in significant physiological and psychological effects on health-care providers.

BackgroundAirway management is a life-saving procedure in the emergency department (ED). Hypoxia during rapid sequence intubation (RSI) is associated with high morbidity and mortality.AimTo decrease the median time of intubation (time from administration of paralytic agent to the successful passage of endotracheal tube) by 40% from baseline 300 s in patients undergoing RSI in the ED.MethodsA multidisciplinary quality improvement team worked to improve the airway management. The bottle necks identified using process mapping and fish bone analysis were lack of formal training of residents and nursing officers, and communication gap between residents and nursing officers. Change ideas focused on training residents in laryngoscopy and intubation and nursing officers in facilitating airway management by preparation of drugs and equipment; on-site awareness of logistical issues to the residents and nursing officers, introducing airway drug checklist and ensuring availability of difficult airway equipment.ResultsAfter implementation of change ideas there was a significant reduction in intubation time. At the end of first Plan-Do-Study-Act (PDSA) cycle median intubation time was 165 s (IQR 125 s). By the end of last PDSA cycle, median intubation time reduced to 157 s (IQR 66 s). A shift was obtained on the run chart with a new median time of 141.5 s from mid-PDSA 1. The 8-week data after the end of PDSA 3 showed sustainability with median time of 126 s (IQR 42 s).ConclusionA well organised team effort, simple change ideas such as structured training of residents and nursing officers, introduction of airway drug checklist and improved communication can decrease the intubation time in a chaotic ED.

Cardiovascular disease is the world's largest killer. Nurses are often the first to activate life support measures when a cardio-respiratory arrest happens. Hence, they should be wellequipped with knowledge and skills of Cardiopulmonary resuscitation to save the life of patient. The aim of the present study was to assess the knowledge and practice of basic life support among nursing officers working in tertiary care hospital, Delhi, India. A cross sectional survey analysis was carried out among 112 nursing officers working in various departments, in March 2019, using convenient sampling technique. A semi structured questionnaire containing knowledge and skill items were used to assess knowledge and skill related to CPR. The results showed average knowledge and poor skill among subjects. Whereas the subjects working in ICU and emergency departments had better knowledge and performance than other selected areas. Both Knowledge and skill were significantly associated with variables like clinical area, in-service training on BLS at p<0.05. The results strongly recommend the need for regular basic life support training sessions for health care professionals.

Emergency departments overcrowding, inadequate nurse patient ratio, wait for start of necessary treatment and lack of communication with family members may lower perceived quality of the patient satisfaction. Aims:To assess the patient satisfaction in terms of nursing care and treatment in emergency department. Material and Methods:The cross sectional descriptive survey was carried among randomly selected 150 patients admitted for >24hrs, in three units of emergency department (Medical emergency, surgical emergency and Trauma emergency) during February to March 2017. Patient satisfaction questionnaire containing 20 items related to admission process, physical environment, ongoing treatment and discharge information was used as tool for data collection. Subjects were interviewed for data collection. Results:The overall quality of care was reported as satisfied by 55% subjects. In further analyzing the components of patient satisfaction, 51% subjects were satisfied for efficiency of admission process and 47% with examination performed by doctor. Whereas dissatisfaction was reported in case of physical cleanliness (59%), high noise level (53%) and lack of potable water and clean toilets by 58% subjects. 61% subjects were satisfied with well explanation of disease condition and 49% with availability of doctors and nurses in emergency. At the same time, subjects reported not satisfaction with components like long waiting times (53%), clinical care (47%), maintaining privacy (41%) and communication (55%). The duration of hospital stay and type of emergency unit had significant association with patients' level of satisfaction at p<0.05. Conclusions:Overall higher numbers of subjects were satisfied with admission process, examination by doctors and explanation of disease condition but unsatisfied with services like long waiting time, communication and clinical care in emergency department.