Annals of emergency medicine
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Editorial Comment
Customer satisfaction versus patient safety: have we lost our way?
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Review Comparative Study
Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy?
The emergency management of primary spontaneous pneumothorax is controversial. This evidence-based emergency medicine review evaluates the existing evidence about the efficacy and safety of needle aspiration in comparison to tube thoracostomy for management of primary spontaneous pneumothorax. ⋯ The existing evidence indicates that needle aspiration is at least as safe and effective as tube thoracostomy for management of primary spontaneous pneumothorax. Additionally, needle aspiration carries the benefit of fewer hospital admissions and shorter length of hospital stay.
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The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. ⋯ A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.
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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.