Hua Hin Medical Journal

Factor Affecting Length of Stay Longer Than 2 Hours of Critical Patients (Triage Level 1,2) in Emergency Department of Hua Hin Hospital, Prachuap Khiri Khan

Flight Lieutenant AORAWAN SAIBUATONG — Thu, 05 Sep 2024 00:00:00 +0700

Background: The use of emergency department services is increasing globally. The subsequent problem is emergency room overcrowding, leading to various issues such as increased waiting times, higher mortality rates, longer hospital stays, staff fatigue, and patient dissatisfaction. The Thai Ministry of Public Health set goals to develop a comprehensive emergency medical care system and referral system (Emergency Care System: ECS) from 2018 to 2022. The target was to have less than 2 hours waiting time for critical emergency patients (levels 1 and 2) in A, S, and M1 level hospitals, aiming to reduce overcrowding and mortality rates. Based on statistics from Hua Hin Hospital (S level hospital), in 2020, only 53.11% of critical emergency patients were seen within 2 hours, which did not meet the ministry's standards. Therefore, researchers studied the data to find the causes.

Objective: To study factors affecting the length of stay longer than 2 hours of critical patients (levels 1 and 2) in emergency department at Hua Hin Hospital, Prachuap Khiri Khan Province.

Methods: Data were collected from the emergency room patient records at Hua Hin Hospital, Prachuap Khiri Khan Province, from October 1, 2021, to September 30, 2022. Statistical analysis using independent t-tests, Chi-square tests, and multiple logistic regression was conducted to identify the factors most strongly associated with a length of stay longer than 2 hours in the emergency room.

Results: A total of 757 patients were included in the study. Factors significantly associated with a length of stay longer than 2 hours in the emergency room were specialized physician consultation at the emergency room (adjusted OR = 3.085, 95% CI 1.716-5.547, P-value < 0.001), endotracheal intubation (adjusted OR = 2.059, 95% CI 1.256-3.375, P-value = 0.004), and the first examining physician being intern (adjusted OR = 1.597, 95% CI 1.093-2.334, P-value = 0.016).

Conclusion: Specialized physician consultation at the emergency room, endotracheal intubation and the first examining physician being intern are the three main factors affecting the length of stay longer than 2 hours in the emergency room for critical emergency patients levels 1 and 2 at Hua Hin Hospital. Further studies are warranted to find solutions to address each factor's issues.

Comparison of Echocardiographic Results in Breast Cancer Patients Before and After Receiving AC Chemotherapy

Daungruthai Pongsubkaroon — Thu, 05 Sep 2024 00:00:00 +0700

Background: Echocardiography, called Echo, is a heart examination that helps in diagnosis of disease, prognosis, and detection of severity as well as effectively monitor the results of treatment for cardiovascular disease. This includes among breast cancer patients receiving AC (Adriamycin and Cyclophosphamide) chemotherapy, who must undergo echocardiography. Because in some patients, abnormal heart rhythms may occur. Therefore, every breast cancer patient should have an echocardiogram. To enable safe and effective treatment of breast cancer patients both before and after receiving AC chemotherapy.

Objective: 1. To evaluate the echocardiographic results in breast cancer patients before and after receiving treatment with AC chemotherapy and 2. To compare the echocardiographic results in breast cancer patients before and after receiving treatment. Treated with AC chemotherapy

Method: This research is a quantitative research. Retrospective data collection form from medical records with a form to record the echocardiography results. The sample group was 233 breast cancer patients treated with AC chemotherapy during the period from fiscal year 2021 to 2023. Data were recorded on 1) The size of the atrial muscle; Left 2) The size of the shape of the left ventricle during relaxation. 3) The thickness of the left ventricular septum during relaxation. 4) The thickness of the back wall that separates the left ventricle during relaxation. 5) The size of Shape of the left ventricle during contraction 6) Volume of blood pumped out of the left ventricle in one contraction 7) Mitral valve 8) Aortic valve 9) Tricuspid valve spid 10) Pulmonary valve and the data was analyzed to find percentage values. Frequency distribution and Dependent sample T-test statistics for comparing echocardiographic results in breast cancer patients before and after receiving treatment with AC chemotherapy.

Results: 1. Personal data of breast cancer patients treated with AC chemotherapy revealed that most were 41-50 years old (41 percent), had chronic diseases, high blood pressure (32 percent), and the stage of their cancer. Breast is stage 2 (37 percent) and the dose of chemotherapy Obtained by calculation from the patient's weight and height, most BSA values are around 1.60 - 1.69 (65 percent). 2. Echocardiographic results of breast cancer patients before and after being treated with AC chemotherapy. It was found that most breast cancer patients both before and after being treated with AC chemotherapy. It is normal. 3. The echocardiographic results of patients with breast cancer after receiving treatment with AC chemotherapy have an average increase before receiving treatment with AC chemotherapy at a level of statistical significance. 0.05

Conclusion: The echocardiographic results of breast cancer patients before and after receiving AC chemotherapy were mostly normal. It was found that the echocardiographic results of breast cancer patients after receiving chemotherapy were normal. AC treatment had an increase in the mean value before receiving treatment with AC chemotherapy at a statistical significance at the 0.05 level.

Efficiency of Computerized Physician Order Entry Process in the Outpatient Pharmacy department, Samut Sakhon Hospital

Janjira Hunpradit — Thu, 05 Sep 2024 00:00:00 +0700

Background: In order to provide quality, convenient, fast, and safer patient services, in 2020 Samut Sakhon Hospital adjusted its outpatient medication dispensing system from previously using prescriptions to a new electronic medication dispensing system (computerized physician ordering entry system: CPOE) along with adding a screening point for the accuracy of physician orders by pharmacists before preparing medication. This study investigates the efficiency of the new prescribing system compared to the previous system.

Objective: To study the incidence of medication errors and mean waiting time before and after implementation of the new electronic prescribing system.

Methods: A retrospective study of medication prescribing errors, transcribing errors, dispensing errors, and average waiting time of the new medication ordering system compared to the traditional prescription system, using data from the HOSxP program and the medication error recording program of the outpatient pharmacy I, Samut Sakhon Hospital, during October 2019-January 2020 (traditional drug prescribing system) and during October 2022-January 2023 (new prescription system: CPOE). The data was analyzed statistically.

Result: After implementing the new medication ordering system, medication prescription errors per 1,000 orders increased from 7.62 to 28.49. Conversely, errors in transcribing orders decreased significantly from 23.67 to 0.24 per 1,000 orders, and errors in medication dispensing dropped from 0.04 to 0 per 1,000 orders. The average waiting time for medication increased from 36:03 to 50:36 minutes, which was statistically significantly different (P < 0.001). However, the average time for the entire medication process remained consistent, with 73:01 and 73:02 minutes for the two systems, respectively.

Conclusion: The new medication ordering system using CPOE with screening of medication orders by pharmacists before preparing medication helps increase the ability to capture medication prescribing errors, reduce transcribing errors and dispensing errors, and increase patient medication safety. The average waiting time for medication has increased, but it has no effect on the average time of the patient’s medication receiving process. Therefore, the CPOE should be studied further with other measures to develop the medication ordering system.