Annals of emergency medicine
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Comparative Study
Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management.
To determine whether radiologists' review of radiographs is unwarranted when emergency physicians are confident in their interpretations. ⋯ Of 9,599 sets of radiographs interpreted confidently by the emergency physicians in this study, there were 11 clinically significant discordant interpretations (0.1%). The standard practice of radiologists' review of all ED radiographs may not be justifiable.
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During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. ⋯ They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.
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Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval represents the time elapsed from ambulance arrival at the hospital until the ambulance reports back in service. ⋯ In this system, ambulance call report documentation required the greatest subinterval of turnaround interval. The turnaround interval and its subintervals varied widely, and radio contact times correlated poorly with observed times at the ED. Attempts at improvement of overall system response through active management of the turnaround interval may be frustrated by reliance on radio-reported availability. [Cone DC, Davidson SJ, Nguyen Q: A time-motion study of the emergency medical services turnaround interval. Ann Emerg Med February 1998;31:241-246.].
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Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval represents the time elapsed from ambulance arrival at the hospital until the ambulance reports back in service. ⋯ In this system, ambulance call report documentation required the greatest subinterval of turnaround interval. The turnaround interval and its subintervals varied widely, and radio contact times correlated poorly with observed times at the ED. Attempts at improvement of overall system response through active management of the turnaround interval may be frustrated by reliance on radio-reported availability.
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The emergency department of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management. [Cordell WH, Overhage JM, Waeckerle JF, for the Information Management Work Group: Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. Ann Emerg Med February 1998;31:172-178.].