Epistemic_Statements  

CORD-19:03d3df2f6a5754f5325e881ff83c35d4d4100fc3 JSONTXT 9 Projects

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Id Subject Object Predicate Lexical cue
T1 416-670 Epistemic_statement denotes We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive.
T2 1345-1557 Epistemic_statement denotes We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities.
T3 1558-1642 Epistemic_statement denotes Patients with MRSA requiring emergency admission must have a bed available for them.
T4 2653-2890 Epistemic_statement denotes 5 In the emergency department (ED), infection prevention and control measures have to be balanced with the requirement to treat patients urgently and to transfer patients requiring admission as quickly as possible to acute hospital beds.
T5 3085-3215 Epistemic_statement denotes 6 We have documented that anything that prolongs patients' ED stay may adversely affect patient welfare and compound overcrowding.
T6 5150-5390 Epistemic_statement denotes Patients with a previous diagnosis of MRSA colonisation and/or infection, whether or not they had negative screens subsequently, were flagged automatically as a 'risk group' (RG) patient on their arrival in the ED using the Oracle database.
T7 5682-5826 Epistemic_statement denotes The Manchester Triage System uses a series of criteria to decide what level of priority patients should have on the basis of their presentation.
T8 6937-7110 Epistemic_statement denotes Clinically stable patients with a prior history of MRSA were isolated, where possible in these rooms, pending the availability of other isolation facilities in the hospital.
T9 7111-7324 Epistemic_statement denotes However, these side rooms do not have separate toilet facilities or an ante room, and frequently the number of patients requiring isolation for MRSA and for other indications exceeds the capacity of the two rooms.
T10 7618-7815 Epistemic_statement denotes The interval time to event analysis determines whether a patient category has an increased or decreased chance of admittance at a particular time point, and the result is defined by a hazard ratio.
T11 7816-7984 Epistemic_statement denotes A multifactorial model was used to examine whether risk group identification was independently significant in the presence of confounding variables such as age and sex.
T12 8592-8737 Epistemic_statement denotes However, female sex, age >65 years and RG status all independently predicted a longer stay in the ED following a request for a hospital bed, i.e.
T13 9460-9610 Epistemic_statement denotes The flagging of patients with a prior diagnosis of MRSA and selective rescreening of this group in this study was associated with a prolonged ED stay.
T14 10149-10374 Epistemic_statement denotes 8, [14] [15] [16] [17] With regards to the limitations of our research, the RG status of a patient is not validated but is assumed to reflect all patients with a previous positive result for MRSA colonisation in our hospital.
T15 10538-10661 Epistemic_statement denotes We have no reason to believe that any failure to do so would have been more prevalent in either those with or without MRSA.
T16 10662-10759 Epistemic_statement denotes Overcrowding in EDs is a distressing and potentially dangerous phenomenon in many health systems.
T17 11194-11430 Epistemic_statement denotes The reason for the delay for females may be due to the fact that our hospital does not usually house males and females in the same bay of a ward, and, as more males are admitted as emergencies, finding a 'female bed' can be problematic.
T18 11572-11820 Epistemic_statement denotes The additional 2.7 h for those requiring selective screening and in an individual patient sick enough to require hospital admission on an already unacceptably long wait for a hospital bed is of concern, and further compounds overcrowding in our ED.
T19 11821-11996 Epistemic_statement denotes Paradoxically, the implementation of screening to identify patients early who require isolation or cohorting in hospital impacts negatively on the provision of emergency care.
T20 11997-12242 Epistemic_statement denotes Overcrowding in EDs has already been shown to increase ambulance diversions to other units, delay treatments, increase waiting times and walkouts and lead to greater lengths of hospital stay as well as increasing patient morbidity and mortality.
T21 12243-12486 Epistemic_statement denotes 7 The early identification and recognition of patients with potentially transmissible diseases and their early isolation is desirable and appropriate, as illustrated by the severe acute respiratory syndrome (SARS) epidemic earlier this decade.
T22 12487-12636 Epistemic_statement denotes However, it is neither desirable nor appropriate that such patients have more prolonged stays in the most overcrowded part of an acute hospital, i.e.
T23 12777-12919 Epistemic_statement denotes 18 However, the ED cannot be expected to house patients for prolonged periods in the absence of isolation rooms or cohort facilities on wards.
T24 13168-13371 Epistemic_statement denotes documented that overcrowding and the rapid turnover of patients in acute hospital settings contribute to cross-infection with MRSA, and they argue that adequate acute capacity would help to address this.
T25 13372-13454 Epistemic_statement denotes 20 Borg has described the correlation between workload indices and increased HCAI.
T26 13455-13712 Epistemic_statement denotes 21 The results of the study reported here show that the selective screening of patients with a prior diagnosis of MRSA colonisation prolongs their ED stay and increases the workload of already busy ED nursing staff, potentially increasing MRSA transmission.
T27 13713-13922 Epistemic_statement denotes Reducing overcrowding in neonatal intensive care units has been shown to be effective in controlling endemic MRSA spread, and it is plausible that reducing ED overcrowding would have a similar positive effect.
T28 13923-14062 Epistemic_statement denotes 22 The delay in being admitted to a ward bed from the ED in this study has been shown to be partly related to selective screening for MRSA.
T29 14215-14330 Epistemic_statement denotes Being able to clarify the patient's MRSA status sooner would probably help to facilitate earlier transfer to a bed.
T30 14331-14407 Epistemic_statement denotes Polymerase chain reaction testing for MRSA may be of benefit in this regard.
T31 14837-15028 Epistemic_statement denotes Having identified the problem, the research hospital has now allocated areas within each ward that allow for the setting up of cohorts of patients with MRSA, if no single rooms are available.
T32 15029-15250 Epistemic_statement denotes Another alternative suggestion is not to selectively screen patients during the ED component of their hospital stay, if doing so would make ward placement more difficult, and to allow patients to be screened on the wards.
T33 15267-15533 Epistemic_statement denotes investigated the use of a universal rapid MRSA admission screening in a surgical department, and although they did not demonstrate a reduction in nosocomial MRSA, they acknowledge that others have recommended universal admission screening as a means to control MRSA.
T34 15534-15906 Epistemic_statement denotes [23] [24] [25] Robiecsek et al., in their study of universal admission MRSA surveillance with isolation and decolonisation of patients who tested positive for MRSA, found that this was associated with a >50% reduction in healthcare-associated MRSA bloodstream, respiratory, urinary tract and surgical site infections during admission and for up to 30 days after discharge.
T35 16247-16467 Epistemic_statement denotes National and local policies for MRSA control need to address this by balancing the welfare of patients in the ED with the need to comply with best practice when there are inadequate ED and inpatient isolation facilities.
T36 16468-16554 Epistemic_statement denotes Patients with MRSA requiring emergency admission to hospital must have a bed to go to.