Hong Kong Journal of Emergency Medicine

A study was carried out in a district hospital located close to the Hong Kong - Shenzhen border, in order to get a picture of the epidemiology of diseases and injuries sustained by Hong Kong residents in China. The emergency medical treatment provided and the degree of patient satisfaction were also analysed. The majority of the patients were adult males. Trauma constituted more than 50% of the attendance, with traffic accident and common assault being the leading causes. This group of Hong Kong residents preferred to be treated in Hong Kong hospitals because of perceived better quality of care. There was a high demand on the local ambulance service and this might have financial and resource implications.

The reduction of mortality from acute myocardial infarction has been achieved mainly through the use of thrombolysis. In large scale studies, mortality and the extent of myocardial salvage are directly related to how early thrombolysis or reperfusion is instituted. This study was done to highlight the factors resulting in time delays that need to be targeted for change: (a) Pre-hospital delays (recognition of symptoms suggesting an acute myocardial infarction and the presentation to the A&E Department); (b) Delays that occur within the A&E Department; and (c) Delays after leaving the Accident & Emergency Department. We identified the areas contributing to significant delays in each of these areas with a view of proposing that a subgroup of these patients may be identified for a fast track approach in initiating thrombolysis within the Accident & Emergency Department.

A three-year retrospective analysis of complaints in an emergency department (ED) in Hong Kong was performed as part of a risk management and quality assurance program for improving patient care and reducing future complaints. The incidence, validity, causes, pattern, legal risk and settlement time of all complaints were studied. From June 1995 to May 1998, there were 71 complaints out of a total of 728040 ED attendance. They were classified into urgent and non-urgent patient groups, yielding a frequency of 0.1 complaint per 1,000 patient visits. Among the 71 complaints, 42 (59%) complaints were judged valid, corresponding to a total of 47 (47%) dissatisfactions. About two third of the complaints had only one dissatisfaction. The frequent dissatisfaction categories were insufficient communication, misdiagnosis and inadequate patient management. Four complaints were potential legal cases but none had subsequent action or claim. More than 51 (70%) complaints were settled within 3 weeks. Regular assessment of complaint is helpful to improve the ED service as well as patient satisfaction.

Patients leaving an Accident & Emergency Department against medical advice are often considered a high-risk group. A prospective study was carried out in an Accident & Emergency Department (ED) to determine the characteristics of this distinct group of patients, their reasons for leaving against medical advice (AMA), and their subsequent outcome. Telephone or personal interview of patients by a clerk was attempted within 48 hours of the visit for all patients who left Against Medical Advice (AMA) based on a pre-set questionnaire. A follow-up call was used to ascertain health outcomes after the discharge. There were 210 AMA cases during the study period giving an incidence of 0.95%. Interview was successful in 186 (88.6%) patients. The mean age of the AMA group was around 36 years but there was no significant difference in sex. The major reasons for AMA included wanting to observe symptoms at home (78 of 186, 42 %), non-medical personal reason (64 of 186, 34%) and symptoms have abated (21 of 186, 11%). Eighteen (9.7%) patients left AMA because they wanted to seek treatment from other providers and among them three had private insurance coverage. Of the 5 (2.7%) patients who were dissatisfied with the management in ED, four disagreed with the diagnosis and treatment offered and the remaining one was unhappy with the attitude of the attending physician. About 12% (22) of patients returned within 48 hours for further treatment and 8 (36%) were admitted. The remaining 22% (40 of 186) sought further medical treatment from other sources. No formal patient complaint was received during the study period from this group.

Computed radiography offers many advantages over the conventional radiography. With new technological breakthroughs and the development of systems that are more cost-effective, there has been an increase in its use in the recent years. However, like all imaging modalities, one must be aware of the various artifacts that are likely to lead to misdiagnosis. In this article, we illustrate the potential hardware and software artifacts that are associated with its use.

Spontaneous pneumomediastinum is a relatively uncommon, infrequently reported entity. In this condition, there is presence of air or gas within the mediastinum that occurs spontaneously. We report a patient with spontaneous pneumomediastinum who presented with complaint of sore throat. There was no other obvious chest symptoms and no known risk factors identified. He was managed conservatively and recovered uneventfully. We undertake to discuss the clinical feature, pathogenesis and management of spontaneous pneumomediastinum.

This is a report of a previously healthy 47-year-old lady who presented to the Accident & Emergency Department (AED) with acute confusion. She was subsequently diagnosed to be suffering from acute disseminated encephalomyelitis (ADEM). We report this rare case to alert emergency physicians to consider acute disseminated encephalomyelitis when presented with a patient with acute confusion. The diagnosis, investigation, management will be discussed.