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Please let us know if you are working on a PhD yourself or if there are interesting PhDs ongoing at your university!
Emergency department (ED) overcrowding is responsible for many adverse events, decreasing the quality and safety of care. Therefore, managing the patient flow is a significant challenge in overcrowded emergency services. In a healthcare system struggling to deal with a growing demand for care, it is essential to ensure patient safety by considering appropriate operational strategies to direct patients to the right place, at the right time, with the appropriate healthcare professional. Various opportunities for regulating ED patient flows can be explored, from clinical decision support tools to guide the patient to the most appropriate level of care to innovative triage systems and pathways of care within departments.
Within the hospital setting, triage systems represent an indispensable tool for patient safety, categorizing the severity of their problem on admission and assigning them an optimal time to first medical contact. Triage systems are complex and composed of 3 main elements: the operator (responsible for the patient assessment), the scale (protocols to identify the severity of the patient’s condition) and the methodology (strategies to dispatch the patient). Although robust and valid triage systems are described, classical approaches seem to be vulnerable to overcrowding and partially succeed in reintegrating the patient into the most appropriate care pathway inside the EDs. New perspectives on triage systems in EDs are needed, and the era of digital health and artificial intelligence could offer some opportunities.
In line with this statement, in the prehospital setting, one exciting triage approach considers using new digital health applications to augment the triage process. Indeed, new strategies of patient flow management investigated the opportunity to consider the patient as the operator of the triage procedure and involve him in his own "self-triage". Although this concept seems to be feasible and safe, it implies the creation of intuitive self-triage tools that must be usable, valid and easily accessible to all.
Ultimately, ED overcrowding is an international public health issue that goes beyond a department’s four walls. Collaborative pathways of care involving primary care providers and emergency physicians could represent an opportunity to manage the still growing demand for care. Implementing original alternative care centers requires the consideration of an appropriate redirection procedure. Redirection operations imply not only the use of a valid triage scale but also the implementation of a new and safe care pathway.
Link to PhD
Gilbert A, Diep AN, Boufraioua M, Pétré B, Donneau AF, Ghuysen A. BMC Health Serv Res. 2022 Sep 23;22(1):1199. doi: 10.1186/s12913-022-08571-5.
Gilbert A, Brasseur E, Ghuysen A, D'Orio V. Rev Med Liege. 2020 Mar;75(3):159-163.
Brasseur E, Gilbert A, Donneau AF, Monseur J, Ghuysen A, D'Orio V. Acta Clin Belg. 2022 Jun;77(3):640-646. doi: 10.1080/17843286.2021.1936353. Epub 2021 Jun 3.
Gilbert A, Ghuysen A. Lancet Digit Health. 2022 Apr;4(4):e210-e211. doi: 10.1016/S2589-7500(22)00001-2. Epub 2022 Mar 9.
Diep AN, Gilbert A, Saegerman C, Gangolf M, D'Orio V, Ghuysen A, Donneau AF. Infect Dis (Lond). 2021 Aug;53(8):590-599. doi: 10.1080/23744235.2021.1903548. Epub 2021 Apr 1.
Gilbert A, Brasseur E, Petit M, Donneau AF, D'Orio V, Ghuysen A. Acta Clin Belg. 2022 Jun;77(3):571-578. doi: 10.1080/17843286.2021.1914948. Epub 2021 Apr 15.
Brasseur E, Gilbert A, Servotte JC, Donneau AF, D'Orio V, Ghuysen A. Acta Clin Belg. 2021 Jun;76(3):217-223. doi: 10.1080/17843286.2019.1710040. Epub 2019 Dec 30.
Brasseur E, Gilbert A, Servotte JC, Ghuysen A, D'Orio V. Rev Med Liege. 2020 Feb;75(2):83-88.
Gilbert A, Piazza J, Szecel J, Ancion A, Gensburger M, Lopez R, D'Orio V, Ghuysen A. Rev Med Liege. 2020 Sup;75(S1):11-17.
Farah Islam completed a BA in Psychology from McGill University (2016) and a MSc in Public Health from the Université de Montréal in (2018) (Montréal, Canada). In 2019, she obtained a Marie Skłodowska-Curie Fellowship from the European Commission and conducted her PhD in Biomedical Sciences at KU Leuven University (2023) (Leuven, Belgium) under the supervision of Prof. Dr. Koen Milisen and Prof. Dr. Marc Sabbe. During her PhD, she aimed to better understand and improve the accuracy of non-clinical operator led telephone-triage services in older adults seeking out-of-hours unplanned care across part of the Flemish region of Belgium.
Overall findings of her research showed that while non-clinical operator led out-of-hours telephone triage services may generally be a safe, and efficient tool for managing unplanned care needs across the population, there still remains large room for improvement with regards to the use of these services for older patients. Although this presented a first step towards addressing this gap in the literature, this research presented important findings to prompt future efforts that are required for improving existing models of care for older adults.
* Islam, F., Milisen, K., Gellens, M., Enckels, J., Kocot, E., Sowada, C., Sabbe. (2022). Changes in the use and uptake of a national out-of-hours telephone triage service by younger and older patients seeking non-urgent unplanned care surrounding the COVID-19 pandemic in Flanders (Belgium). Acta Clinica Belgica, 1-9. https://doi.org/10.1080/17843286.2022.2068296
* Mooijaart, S., Lucke, J., Heeren, P Singler, P., McNamara, R., Gilbert, T., Nickel, C., Castejon, S., Mitchell, A., Mezera, V., Van der Linden, L., Lim, S., Thaur, A., Karamercan, M., Blomaard, L., Islam, F., Dundar Z., Cheung K, De Groot, B., Conroy, S. (2021). Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. European Geriatric Medicine, 13(2), 309-317. https://doi.org/10.1007/s41999-021-00578-1
* Islam, F., Sabbe, M., Heeren, P., Milisen, K. (2021). Consistency of decision support software‑integrated telephone triage and associated factors: a systematic review. BMC Medical Informatics and Decision Making, 21(107), 1-10. https://doi.org/10.1186/s12911-021-01472-3
EARLY CARE MANAGEMENT AFTER CARBON MONOXIDE POISONING BASED ON CARBOXYHEMOGLOBIN TOXICOKINETIC: ON NON-INVASIVE VENTILATION AFTER ACUTE CARBON MONOXIDE EXPOSURE ON SWINE MODEL.
This thesis addresses the toxicokinetics of carboxyhaemoglobin (COHb) after acute carbon monoxide (CO) intoxication treated by non-invasive ventilation on a swine model. This toxicokinetic approach confirms a bi-compartmental elimination of COHb in general and suggests that calculation of the COHb half-life (COHbt1/2) could be useful for estimating the extra-vascular CO storage and the severity of CO intoxication. In addition, for the first time, we observed a rebound in COHb after treatment on normobaric oxygenation.
In addition, we published the largest review of the affinity of CO for hemoglobin (M value) in the animal world, which varies according to species, and we confirm the human M value at 218. This value should become the reference in the literature on CO. In the light of these results, we propose recommendations for clinicians and for future studies on the subject.
* Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, et al. Effect of Pressure Support Ventilation on Carboxyhemoglobin Toxicokinetic after Acute Carbon Monoxide Intoxication: a Swine Model. J Med Toxicol. 2018;14(2):128-33.
* Delvau N, Penaloza A, Liistro G, Thys F, Megarbane B, Hantson P, et al. Relative Affinity M Constant of Adult and Fetal Hemoglobin for Carbon Monoxide in Humans: a Systematic Review and Meta-Analysis. Human Physiology. 2020; 46:191-9.
* N. Delvau, A. Penaloza, G. Liistro, F. Thys, B. Megarbane, Ph. Hantson, PM Roy. Report on the relative affinity constant (M) of hemoglobin for carbon monoxide in the animal world: a comparative review with a meta-analysis based on a systematic review. Journal of Evolutionary Biochemistry and Physiology, 2019, Vol.55, N°5, PP 348-364.
* N. Delvau, L. Elens, A. Penaloza, G. Liistro, F. Thys, P.M. Roy, P. Gianello, P. Hantson. Carboxyhemoglobin half-life toxicokinetic profile during and after normobaric oxygen therapy: on a swine model. Toxicology Reports (Submitted; Jun 01 2023).
* N. Delvau, A. Penaloza, V. Franssen, F. Thys, P.M. Roy, Ph. Hantson. Unexpected carboxyhemoglobin half-life during cardiopulmonary resuscitation: a case report. International Journal of Emergency Medicine (2023) 16:22.