Journal reviews: Health status and intimate partner violence; analyzing medical errors; hospital preparedness for weapons of mass-destruction
Journal reviews
Brokaw J, Fullerton-Gleason L, Olson L, et al. Health status and intimate partner violence: A cross-sectional study. Ann Emerg Med 2002; 39:31-38.
Women with a recent history of intimate partner violence self-reported a poorer health status than women with no history of abuse, says this study from the University of New Mexico Health Sciences Center in Albuquerque. A total of 421 women between the ages of 18 and 50 who presented to a large urban ED were screened for a history of physical abuse, received urine and blood tests and a pelvic examination, and were interviewed several days later.
The study found that women with a history of physical abuse reported more cocaine use, more frequent history of sexually transmitted diseases, and higher frequency of nightmares. "Experiencing frequent nightmares may both be an indicator of abuse and an important consequence that requires treatment," the researchers wrote.
However, urine and blood tests identified only two variables (hemoglobin levels and mean corpuscular volume) that differed significantly between the two groups of women. This may be because the laboratory tests represented a "one-time snapshot" and would not detect evidence of previous drug use or infectious diseases, the researchers theorize.
They note that nearly half the women screened reported intimate partner violence. "Our study underscores the need for universal screening for [intimate partner violence] among all female patients presenting to EDs for any type of care," the researchers wrote. (Editor’s note: For more information on domestic violence screening, see "Do you selectively screen for victims of domestic violence?" ED Nursing, August 2000, p. 121.)
Battles JB, Shea CE. A system of analyzing medical errors to improve GME curricula and programs. Acad Med 2001; 76:125-133.
Researchers at the Rockville, MD-based Agency for Healthcare Research and Quality performed a root-cause analysis of "near-miss" medical errors by graduate trainees (interns, residents, and fellows). The study includes the following two cases that occurred in EDs:
• A patient was almost sent home with a fractured cheekbone late on a busy Friday night. The ED was understaffed, and several graduate trainees who were inexperienced in reading X-rays missed the fracture. The error was caught by an experienced charge nurse who overheard them discussing the case.
• Patients were given inadequate medication for acute asthma in a busy, understaffed ED over a two-month period. During this time, the individual responsible for lecturing about asthma medication protocols was out of town, but no one else presented the information. The discrepancy in treatment was discovered after a chart audit of asthma cases in the ED.
In both cases, lack of knowledge on the part of the trainee contributed to the medical errors, which had the potential for significant harm to the patient, say the researchers. Studying the root causes of near-misses can be a valuable source of information to prevent future errors, they add.
"Near-miss reporting systems can be effective error management tools," they write. "It has been shown that graduate trainees are willing to report errors if they are provided with a no-fault confidential reporting mechanism." (Editor’s note: For more information on medication errors, see "Are your patients at risk for medication errors? Here’s how to avoid mistakes," ED Nursing, September 2000, p. 133.)
Treat KN, Williams JM, Furbee PM, et al. Hospital preparedness for weapons of mass-destruction incidents: An initial assessment. Ann Emerg Med 2001; 38:562-565.
Hospitals are not prepared to handle disasters involving weapons of mass destruction (WMD), says this study from the Center for Rural Emergency Medicine in Morgantown, WV. ED medical directors and nurse managers were interviewed at 22 rural and eight urban hospitals about level of preparedness, including large-scale decontamination capabilities, communication, staff training, and security. Here are key findings:
- None of the respondents believed their facilities were fully prepared for a biologic incident.
- No facility reported having lines of communication free of system failures.
- • Regarding decontamination for a WMD event, 73% of respondents said they would set up a single-room decontamination process.
- The majority of respondents (87%) said their EDs could manage 10-50 casualties at one time.
- Only one facility had stockpiled any medications for WMD treatment.
- None of the hospitals had prepared media statements to use if a WMD incident occurred.
- Only one-fourth of the hospitals reported that staff had received any training in managing a WMD event, although all reported a need for this training.
- Half of the hospitals were able to perform a hospitalwide lockdown, and 96% reported no awareness regarding the threat of a secondary device.
The researchers conclude that there are significant gaps in knowledge and skill among ED staff, including mass decontamination, health communications, and facility security. They add that that rural hospitals that rely on local emergency medical services (EMS) personnel to perform decontamination is a particularly distressing problem. "This is of concern, because up to 80% of disaster victims may seek hospital care without accessing EMS," they wrote.
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