Annals of emergency medicine
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To report the distribution of emergency department costs by category of expense and level of patient urgency. ⋯ The distribution of ED costs varies significantly according to the urgency of the medical condition. For nonurgent patient visits, most costs are represented by the hospital facility and ED physicians' costs. Ancillary services represent a much greater proportion of costs for patients with urgent conditions. Although reduced test-ordering might result in some savings among patients with urgent conditions, overall improved cost efficiency can be achieved only through reductions in the fixed costs of operation of hospital EDs.
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The traditional (and unvalidated) five-point Cerebral Performance Category (CPC) score at hospital discharge does not correlate with the results yielded by a validated functional status instrument and subjective quality-of-life assessment. ⋯ The CPC score, relied on as a measure of functional outcome in cardiac arrest, correlates poorly with subsequent subjective quality of life and with validated objective functional testing instruments, and conclusions based on it are suspect. Future researchers should employ standardized testing instruments.
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To determine the effectiveness of life support courses for health care providers on the basis of one of three outcomes: (1) patient mortality and morbidity, (2) retention of knowledge or skills, and (3) change in practice behavior. ⋯ Among providers, retention of knowledge and skills acquired by participation in support courses is poor. However, refresher activities increase knowledge retention. Modular courses are as good as lectures for learning course material. There is evidence that use of the Advanced Trauma Life Support course has decreased mortality and morbidity. Further studies of patient outcome and provider behaviors are warranted.
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To determine whether race/ethnicity is an important determinant of emergency department use. ⋯ Race/ethnicity was not an important determinant of ED use after adjustment for age, health insurance coverage, regular source of care, and barriers to health care. Population-based studies of ED use should be conducted to further evaluate whether racial/ethnic differences in ED use exist that are not explained by differences in demographics, health, socioeconomic status, access to care, or other determinants of ED use.