Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2014
ReviewReview article: What makes a good healthcare quality indicator? A systematic review and validation study.
Indicators measuring aspects of performance to assess quality of care are often chosen arbitrarily. The present study aimed to determine what should be considered when selecting healthcare quality indicators, particularly focusing on the application to emergency medicine. Structured searches of electronic databases were supplemented by website searches of quality of care and benchmarking organisations, citation searches and discussions with experts. ⋯ Although using the tool took more time than implicit gestalt decision making: median (interquartile range) 190 (43-352) min versus 17.5 (3-34) min, their rankings changed after using the tool. To inform the appraisal of quality improvement indicators for emergency medicine, a comprehensive list of indicator attributes was identified, validated, developed into a tool and piloted. Although expert consensus is still required, this tool provides an explicit basis for discussions around indicator selection.
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Emerg Med Australas · Apr 2014
ReviewReview article: Elevated troponin: Diagnostic gold or fool's gold?
Troponin is a highly sensitive biomarker of myocardial injury and has been used extensively in everyday clinical practice in the community as well as in hospitals for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of patients with acute coronary symptoms. Dynamic elevations in biomarkers (troponin) are considered fundamental to the diagnosis of AMI. ⋯ An incorrect diagnosis of myocardial infarction can also lead to the oversight of serious life-threatening alternative causes of troponin elevation (e.g. pulmonary embolism). This article discusses the role of troponin in our everyday clinical practice in the ED.
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Emerg Med Australas · Apr 2014
ReviewReview article: Ventricular assist devices in the emergency department.
Ventricular assist devices (VADs) have become an indispensable tool in the management of end-stage cardiac failure, both as a means of bridging to cardiac transplantation and as destination therapy for long-term quality of life improvement. Although the technology continues to advance and these devices continue to be refined, they are still associated with significant complications. This article reviews the basics of VAD function and physiology, as well as the myriad to complications that follow their implantation. This review aims to provide a systematic approach to the troubleshooting, diagnosis and management of both VAD-associated complications and the resuscitation of the decompensated VAD patient presenting to the ED.