Retrospective study of the incidence of unstable and shock patients presenting to the emergency room.
BACKGROUND
Over a period of three decades, medical personnel working in our emergency room observed that fewer severe cases presented to the emergency department. The objective of this study is to assess whether a genuine change in the presentation rates of clinically unstable non-trauma patients to the emergency room indeed exists.


METHODS
We conducted a retrospective review of patients treated in the shock room. Patients' demographic data, diagnoses and outcomes were accessed. Populations of patients presenting to the shock room over a span of four seasons, in two separate periods eight years apart were compared. This rate was compared with the complementary bulk rate of patients presenting to the emergency room at the center.


RESULTS
While absolute rates of emergency room utilization rose, the rate of unstable patients demanding urgent intensive care showed a clear decline. An absolute reduction of close to 50% across the different seasons of the examined years was found. Per patient, the proportion of those requiring artificial respiration and urgent hemodialysis remained uniform in both periods. All parameters of patient outcomes were similar in both periods of the study.


CONCLUSIONS
This unexplored aspect of emergency care demonstrates a dramatic decline in the incidence of unstable patients. While we should continue to reinforce delivery of superior care, our medical educational system should adapt itself to compensate for the diminished exposure of our trainees to emergencies. Further research in this field should explore whether the trend we observed exists in other geographical locations and whether this parameter can be utilized as a quality measure of medical systems.
Elon Moreh Health Center, Clalit Health Services, Shomron, Israel ; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Emergency Medicine Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105 Israel.
Sody A
SA
Naimer
The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Moshe Y
MY
Prero
Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Tamar
T
Freud
Emergency Medicine Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Carmi
C
Bartal
Altering rates; Emergency room; Intensive care; Shock room; Unstable patients