Response of a local hospital to a burn disaster: Contributory factors leading to zero mortality outcomes

Yeong, Eng-Kean; O’Boyle, Ciaran P.; Huang, Hui-Fu; Tai, Hao–Chih; Hsu, Yen-Chun; Chuang, Shu-Yang; Wu, Yu‐Feng; Chang, Chieh; Liu, Tom J.; Lai, Hong‐Shiee

doi:10.1016/j.burns.2018.03.019

Cited by 13 publications

(5 citation statements)

References 26 publications

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“…ED utilization increased by 10.7%, and ED expanse increased by 29.4%, during the seven-year observation period. The effectiveness of hospital ED regionalization and categorization in Taiwan has been documented in terms of improved patient outcomes for acute myocardial infarction [66], ischaemic strokes [33], and burn injury [67,68]. In 2015, nearly 500 injuries from severe burns occurred following a color-dust explosion in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

Lin

Lee²

2020

Preprint

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Background: The goal of this study was to examine the effect of hospital emergency department (ED) regionalization policy and the categorization of hospital emergency care policy (categorization policy) on patient appropriate ED use.Methods: We conducted an observational study of the effect of emergency care policy intervention on patients' visits. Seven years of data from the Taiwan National Health Insurance Research Database (NHIRD) were examined. Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization policies in 2007 and 2009, respectively. There were 1,835,860 ED visits found among one million random samples from the NHIRD between 2005 and 2011. ED visits were categorized by the modified New York University ED algorithm. A time series analysis was performed to examine the change in the rate of appropriate ED use after the policy took effect.Results: Total ED visits increased by 10.7% from 2005 to 2011. Average appropriate ED visit rate was 66.9% during the policy intervention. The trend in the appropriate ED visit rate showed no significant policy effect.Conclusions: Provider side of regionalization and categorization policies did increase emergency care accessibility. However, regionalization and categorization policies no significant effect on patient appropriate ED use.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

Lin

Lee²

2020

Preprint

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“…[1] This closely linked MCI response mechanism, along with surges in pre- and posthospital medical care and hospital capacities motivated by the health authorities, contributed to the effective and efficient handling of the acute phase of this BMCI. [2,3]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Eventually, this BMCI caused 15 deaths. [2] The extremely low mortality rate of patients with high total body surface area (TBSA) burn injuries resulting from this MCI has been attributed to several crucial factors, including centralization of the emergency response, and resource allocation. [3] Overcrowded EDs hinder the ability of hospitals to handle demand surges during crises and to properly prioritize treatment on the basis of urgency.…”

Section: Introductionmentioning

confidence: 99%

The crowd-out effect of a mass casualty incident

et al. 2019

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A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident. We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database. On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ± 4.21 hours vs 3.77 ± 2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers. Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

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“…Large burn injuries often require aggressive fluid resuscitation for the first 24 to 48 hours after the initial burn injury to prevent hypovolemic shock. Many patients will also require vasopressors for hemodynamic support 9. These should be used for shock management and shouldn't be used as a replacement for adequate fluid resuscitation.…”

Section: Initial Burn Managementmentioning

confidence: 99%

“…Many patients will also require vasopressors for hemodynamic support. 9 These should be used for shock management and shouldn't be used as a replacement for adequate fluid resuscitation. Norepinephrine is recommended as the first-line vasopressor in patients with burns.…”

Section: Burn Shock and Fluid Resuscitationmentioning

confidence: 99%