Improving testicular examinations on paediatric patients in the emergency department:A quality improvement study to improve early diagnosis of testicular torsion

Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(p<0.001).Subgroup analysis found doctors in training had a greater improvement in both rate and quality of documented testicular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a decreased risk of missed and delayed diagnosis of testicular torsion.

Training indicators and quantitative criteria for emergency nurse specialists

Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of indicators was designed on the basis of system theory and the balanced scorecard method. Meanwhile, corresponding quantitative standard indicators were compiled through literature analysis and a review of training characteristics. Next, screening indicators were collected through consultation with experts and statistical calculations. The indicators weight coefficient was calculated using the analytic hierarchy process（AHP）. Finally, indicators were validated in two groups of nurses in two different training courses.Results：（1） We created a three-level indicator system： level-Ⅰ dimensions have 4 indicators, while level-Ⅱ dimensions and level-Ⅲ dimensions have 13 and 34 indicators, respectively;（2） The coefficient of expert＇s judgment is 0.840, familiarity is 0.914 and authority is 0.877, and the three rounds of coordination coefficient are 0.456, 0.553 and 0.715, respectively;（3） There are at least 56 indicators in alternative quantitative standards; and（4） The alpha reliability value of the indicator system in the two training course had no significant difference（P 〉 0.05）. The same result was observed when examining two groups of nurses in one training course（P 〉 0.05）.Conclusions： This study established a training system of quality evaluation standards for emergency nurse specialists that is objective, reliable, easy to operate and representative according to scientific selection and verification. This system can therefore provide a basis for quality evaluation and targeted improvement for ENS training in addition to promoting health.

Effect of emergency nursing on the efficiency and quality of emergency care for patients with acute coronary syndrome

Background Acute coronary syndrome(ACS)is a common cardiovascular disease that typically occurs with a greater frequency in older adults,men and postmenopausal women.Methods A total of 62 patients with ACS admitted to our hospital from February 2021 to May 2023 were enrolled and divided into observation group and control group by the random number table method,with 31 cases in each group.The control group was given routine nursing,and the observation group was given additional emergency nursing on the basis of routine nursing.The emergency efficiency,emergency quality and quality of life were compared between the two groups.Results The emergency efficiency related indexes such as the time of triage,blood collection,referral time,and time spent on rescue after clinical reception was lower than that of control group(P<0.05).The emergency quality scores of emergency order,equipment preparation,nursing service,ward management and effective communication in the observation group were higher than those in the control group(P<0.05).The scores of 8 Quality of Life(QOL)dimensions in the observation group were higher than those in the control group(P<0.05).Conclusion Emergency nursing can improve the emergency efficiency and quality of ACS patients,and the quality of life of patients after emergency can be significantly improved as well,which is worthy of popularization and application.