Annals of emergency medicine
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Comparative Study
Epidemiologic patterns of injuries treated in ambulatory care settings.
Epidemiologic studies of injury morbidity have relied primarily on data from emergency departments (EDs) and hospital admissions. We seek to assess the incidences and characteristics of acute injuries treated at EDs and other ambulatory care settings. ⋯ Fewer than half of all medically attended acute injuries in the United States receive initial treatment in EDs. Injury severity and characteristics vary among care settings.
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Comparative Study
Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen.
Patients who leave before being seen by a physician represent a significant problem for many emergency departments (EDs). We sought to determine the effect of a new ED rapid entry and accelerated care at triage (REACT) process on the frequency of patients who leave before being seen. ⋯ The initiation of a rapid entry and accelerated care process significantly decreased patient leave before being seen rates, average wait times and length of stay, despite an overall increase in patient census.
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Comparative Study
Accuracy of ECG interpretation in the pediatric emergency department.
We assess accuracy of ECG interpretation and indications for obtaining ECGs and develop a clinical classification system of ECG abnormalities. ⋯ We conclude that, overall, a high rate of concordance exists between the pediatric emergency physician's and the cardiologist's ECG interpretation. The majority of discordant ECGs are not clinically significant. However, among the clinically significant ECGs, there is a higher rate of discordance. These data suggest that review of pediatric ECGs by pediatric cardiologists may significantly reduce underdetection of clinically important ECG findings in children.
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We evaluate the association between emergency physicians' fear of malpractice and the triage and evaluation patterns of patients with symptoms suggestive of acute coronary syndrome. ⋯ Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.