Annals of emergency medicine
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Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED. ⋯ Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.
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Good communication is important in patient care and plays an essential part of teamwork and patient safety. Communication in the emergency department (ED) can be chaotic, with the potential for error resulting from communication overload and problems of communication. The nurse in charge of the ED plays a crucial role in maintaining communication flow. The aims of this study are to identify the features of the communication load on the nurse in charge of the ED. ⋯ These findings are an important measure of communication load, which can disrupt memory and lead to mistakes. Improving communication between health care staff by reducing the levels of interruptions and minimizing the volume of irrelevant or unnecessary information exchange could therefore have important implications for patient safety.
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Comparative Study
Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department.
In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED). ⋯ Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain. In particular, the verbal numeric scale is not in agreement with the other evaluated scales.
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We identify the incidence, nature, and consequences of medication errors among acutely ill and injured children receiving care in a sample of rural emergency departments (EDs). ⋯ We found a high incidence of medication errors and physician-related medication errors among the acutely ill and injured children presenting to rural EDs in northern California. None of the medication errors identified caused harm to the patients included in this study.
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We illustrate how audio-video data records can improve emergency medical care, using airway management to show how such video data may help to identify unsafe acts, accident precursors, and latent and systems failures and to evaluate performance. ⋯ Video is complementary to traditional quality improvement methods for improving performance in airway management and emergency medical and trauma care, assessing standard operating procedures, and reviewing communications. Video data identify performance details not found in quality improvement approaches, including medical record review or recall by participant care providers. Weaknesses in using video for data include lengthy video review processes, poor audio, and the inability to adequately analyze events outside the field of view. Opportunities are to use video audit for quality improvement of other emergency tasks. Video buffering reduces personnel requirements for capture and simplifies data extraction. Medicolegal and confidentiality threats are significant.