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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 83-86

Emergency department visits of staff and students of a large medical college and hospital in South India


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication9-Nov-2018

Correspondence Address:
Dr. Kundavaram Paul Prabhakar Abhilash
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_9_18

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  Abstract 

Background: The emergency department (ED) is always kept busy by patients requiring urgent health care. A part of the patients is the staff and students of the very institute running the ED. Sick staff and students are a liability as they contribute to economic loss and loss of person-hours of the institute. Materials and Methods: The retrospective cross-sectional study done in Christian Medical College, Vellore, included all staff and students who presented to the ED during the period of January 2014–December 2014. Results: During the study period, a total of 54,562 patients presented to the ED with various complaints. A total of 956 staff and students comprised 2.8% (1528/54,562) of all the emergency visits. There were 1350 staff visits and 178 student visits during the 1-year study period. More than half (57.5%) had general medical complaints and only required pharmacological therapy. A quarter of the staff and students (25.5%) presented to the ED with trauma with more than half of those being road traffic accidents. Univariate analysis for risk factors for trauma among staff had been carried out and the results were summarized. Class 3 and 4 employees had a higher incidence of trauma (21.6% vs. 12.6%, P < 0.001; odds ratio [OR] = 1.91 [95% confidence interval (CI): 1.43–2.55]) as also males (25.8% vs. 11.8%; P < 0.001; OR = 2.6 [95% CI: 1.94–3.48]). Conclusions: A significant number of staff and students present to the ED with trauma with males and class 3 and 4 employees having a higher risk. In addition, acute febrile illness present in specific seasonal patterns through the year and are the most common presentations to the ED.

Keywords: Emergencies, emergency department, profile, staff, students


How to cite this article:
Ahikam D, Karun S S, Abhilash KP, Alex RG. Emergency department visits of staff and students of a large medical college and hospital in South India. Curr Med Issues 2018;16:83-6

How to cite this URL:
Ahikam D, Karun S S, Abhilash KP, Alex RG. Emergency department visits of staff and students of a large medical college and hospital in South India. Curr Med Issues [serial online] 2018 [cited 2018 Dec 15];16:83-6. Available from: http://www.cmijournal.org/text.asp?2018/16/3/83/245043


  Introduction Top


A healthcare worker is one who provides care and services to the sick and ailing either directly as doctors and nurses or indirectly as attenders, technicians, secretaries, security personnel, or even medical waste handlers. There are approximately 59 million healthcare workers worldwide.[1] The healthcare industry is one of the most hazardous places to work in because of the various infectious, chemical nuclear compounds in the environment. Hence, both staff and students of teaching institutes are repeatedly exposed to a hazardous environment in addition to the nonoccupational dangers faced in everybody's daily life. The emergency department (ED) is kept awake both day and night by patients requiring urgent health care. A part of the patients is the staff and students of the very institute running the ED. Sick staff and students are a liability as they contribute to economic loss and loss of person-hours of the institute. To overcome these hurdles, preventive strategies have to be devised to see these numbers dwindle. As a foundation for this, the disease pattern among the staff and students presenting to the ED must be known. There is a paucity of research into the hazards faced by health care workers in our country, and hence we conducted this study.


  Materials and Methods Top


The study is a cross-sectional, retrospective study was done in the ED of Christian Medical College (CMC), Vellore. The ED is a 45-bedded emergency with a triage-based priority system which receives an average of 200–240 patients a day. All staff and students of CMC Vellore who came to the ED during the period January 2014–December 2014 were included in the study. The study was observational, and hence, no clinical intervention was performed. The staff and students were noted through their hospital numbers from the triage register maintained at the ED. Then, the necessary demographic details, cause of their visit, and its outcome were gathered from the hospital's digital database: Clinical Workstation. The details collected include date of visit, gender, age, class of occupation, number of visits in 2014, duration of stay (if admitted), diagnosis, and outcome. The collected data were entered into Microsoft Excel spreadsheet. The data collected were analyzed with the help of the open source software: PSPP. Descriptive statistics such as frequencies and cross-tabs were obtained from the data collected. The employees and students of the institute were classified as follows:

  • Class 1: Professors, assistant professors and administrative heads
  • Class 2: Staff nurses, interns, post-graduate registrars, and junior doctors
  • Class 3: Technical staff
  • Class 4: Attendants and the housekeeping staff
  • Students: M.B.B.S, nursing, and allied health science students.


Statistical methods

Frequency distribution was performed on gender, employment class, and age to know the baseline characteristics of the study population. Diseases were categorized under the specialty of management, and their distribution among the various classes of employment was tallied. In addition, a frequency distribution was done for a few diseases month-wise. Few preventable illnesses were identified (preventable illness – road traffic accidents, accidental falls and injuries) and bivariate analysis was performed to look for significant risk factors. Then a multivariate logistic regression was done to isolate the true risk factor. This study was approved by the Institutional Review Board, and patient confidentiality was maintained using unique identifiers and by password protected data entry software with restricted users.


  Results Top


During the study period, a total of 54,562 patients presented to the ED with various complaints. A total of 956 staff and students comprised 2.8% (1528/54,562) of all the emergency visits. There were 1350 staff visits and 178 student visits during the 1-year study period. There was a clear female predominance (68.1%). Majority were in the 16–35 years' age group. The baseline characteristics are shown in [Table 1]. The disease profile and the main departments involved are shown in [Table 2]. More than half (57.5%) had general medical complaints and only required pharmacological therapy. A quarter of the staff and students (25.5%) presented to the ED with trauma with more than half of those being road traffic accidents [Table 3]. Univariate analysis for risk factors for trauma among staff is shown in [Table 4]. Class 3 and 4 employees had a higher incidence of trauma (21.6% vs. 12.6%, P < 0.001; odds ratio [OR] = 1.91 [95% confidence interval (CI): 1.43–2.55]) as also males (25.8% vs. 11.8%; P < 0.001; OR = 2.6 [95% CI: 1.94–3.48]). The two variables were analyzed on multivariate logistic regression analysis with class 3 and 4 employees having a statistically significant adjusted OR of 238 (95% CI: 1.65–3.42) and males having an OR of 1.16 (95% CI: 0.81–1.67). The risk factors for trauma among MBBS, nursing, and allied health science students are shown in [Table 5].
Table 1: Baseline characteristics

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Table 2: Disease profile of patients (n=1528)

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Table 3: Mode of injury among trauma patients (n=244)

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Table 4: Risk factors for trauma among staff (n=1350)

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Table 5: Risk factors for trauma among students

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  Discussion Top


Our study showed the spectrum of presentation of emergencies among staff and students of a large teaching institution. The gender and age distribution of the study population is reflective of the distribution among staff and students of the institute. As one would expect from any ED, most of them required medical management. This is consistent with the general predominance of medical conditions, especially infections in our locality. Scrub typhus, dengue fever, typhoid, and chikungunya fever are endemic in this part of the country. Another contributing factor perhaps is inadequate personal hygiene with regard to hand washing in an environment teeming with various pathogens.[2]

Trauma is a major cause of morbidity and mortality in both developed and developing countries. Nearly 17% of those that came to our ED presented with trauma. This comprised those who presented with road traffic accidents, accidental falls, and injuries. These are group of events that can be prevented with adequate safety measures and caution. On analyzing for associated risk factors with presenting with trauma, it is evident from the results that a male staff presented nearly twice as frequently with trauma than others. The safety measures that the men daily employ can be assessed and appropriate preventive measures can be adopted. The safety measures include wearing seatbelts on four-wheelers and helmets on two-wheelers and following strict traffic rules which is seldom followed in our country.

Absenteeism from work due to illness is a major concern for any institution. Studies done in the West on absenteeism in the ED show a difference in various staff groups.[3] Unlike India, where febrile illnesses are very common, conditions such as low back pain are very common causes for sick leaves in the West.[4] Psychosocial factors may contribute to long-term sickness absence with burnout being a key factor.[5] These issues have to be addressed in every department of large institutions. Another uncommon factor is outbreaks of infections such as acute gastroenteritis which may lead to a large number of absentees suddenly.[6],[7]

A healthcare worker is in need of protection from these workplace hazards just as much as any other category of workers such as miners or construction workers.[8] Emergencies due to needlestick injuries to healthcare workers pose a significant risk for HIV, HCV, and HBV. It is very unfortunate that many healthcare workers die every year from occupational HIV, which can and should have been prevented. Our study did not include emergencies due to needlestick injuries as there are handled separately and immediately by the staff–student health duty doctor. The number of staff–student emergencies would have been much higher had we included needlestick injury emergencies.


  Conclusions Top


A significant number of staff and students present to the ED with trauma with males and class 3 and 4 employees having a higher risk for trauma. Furthermore, acute febrile illness present in specific seasonal patterns through the year and are the most common presentations to the ED.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Joseph B, Joseph M. The health of the healthcare workers. Indian J Occup Environ Med 2016;20:71-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection control program. Ann Intern Med 1999;130:126-30.  Back to cited text no. 2
    
3.
Rugless MJ, Taylor DM. Sick leave in the emergency department: Staff attitudes and the impact of job designation and psychosocial work conditions. Emerg Med Australas 2011;23:39-45.  Back to cited text no. 3
    
4.
Steenstra IA, Koopman FS, Knol DL, Kat E, Bongers PM, de Vet HC, et al. Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals. J Occup Rehabil 2005;15:591-605.  Back to cited text no. 4
    
5.
Peterson U, Bergström G, Demerouti E, Gustavsson P, Asberg M, Nygren A, et al. Burnout levels and self-rated health prospectively predict future long-term sickness absence: A study among female health professionals. J Occup Environ Med 2011;53:788-93.  Back to cited text no. 5
    
6.
Cáceres VM, Kim DK, Bresee JS, Horan J, Noel JS, Ando T, et al. A viral gastroenteritis outbreak associated with person-to-person spread among hospital staff. Infect Control Hosp Epidemiol 1998;19:162-7.  Back to cited text no. 6
    
7.
Vardy J, Love AJ, Dignon N. Outbreak of acute gastroenteritis among emergency department staff. Emerg Med J 2007;24:699-702.  Back to cited text no. 7
    
8.
Marnejon T, Gemmel D, Mulhern K. Patterns of needlestick and sharps injuries among training residents. JAMA Intern Med 2016;176:251-2.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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