Annals of emergency medicine
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Multicenter Study Comparative Study
The emergency department occupancy rate: a simple measure of emergency department crowding?
We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. ⋯ The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.
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We study the impact of emergency department (ED) crowding on delays in treatment and nontreatment for patients with severe pain. ⋯ ED crowding is associated with poor quality of care in patients with severe pain, with respect to total lack of treatment and delay until treatment.
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We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of beta-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change. ⋯ Findings from this study could be used to inform a change program to close the gap between evidence and practice with respect to use of inhalers and holding chambers in the ED.
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Inhaled bronchodilators are often used in the emergency department (ED) before a definitive diagnosis is made. We evaluated the association between inhaled bronchodilators and outcomes in acute decompensated heart failure patients without chronic obstructive pulmonary disease. ⋯ Many acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease receive inhaled bronchodilators. Bronchodilator use was associated with a greater need for aggressive interventions and monitoring, and this may reflect an adverse effect of bronchodilators or it may be a marker for patients with more severe disease.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: Emergency department (ED) crowding may result in delays in the administration of medication such as antibiotics for pneumonia. WHAT QUESTION THIS STUDY ADDRESSED: Does crowding cause delays in treatment for pain? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In this retrospective analysis of 13,578 patients treated at a single inner-city ED, patients with severe pain were slightly less likely to receive pain medications quickly when the ED volume increased. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Crowding may delay the administration of pain medication in some patients. Standing orders for the administration of pain medication might mitigate such delays.