Annals of emergency medicine
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We identify hospital-level factors from the administrative perspective that affect the availability and delivery of palliative care services in the emergency department (ED). ⋯ Though hospital administration at 3 urban hospitals on the East coast has great interest in integrating palliative care and emergency medicine to improve quality of care, patient and family satisfaction, and decrease length of stay for admitted patients, palliative care staffing, medicolegal concerns, and logistic issues need to be addressed.
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Medicare's new, mandatory Hospital Inpatient Value-Based Purchasing Program introduces financial rewards or penalties to hospitals according to achievement or improvement on several publicly reported quality measures. Our objective was to describe hospital reporting on the 4 emergency department (ED)-related program measures, variation in performance on the ED measures across hospital characteristics, and the characteristics of hospitals that were more likely to receive performance scores based on improvement versus achievement. ⋯ We found variation in performance by hospital characteristics on the ED-related program measures. Although public and non-TJC-accredited hospitals trailed in performance, they showed strong signs of improvement, signaling that performance gaps by ownership and accreditation may decrease. Considering the increasing scope of the value-based purchasing program, ED leaders should monitor both achievement and improvement on the 4 ED-related program measures.
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Review
Systematic review of strategies to manage and allocate scarce resources during mass casualty events.
Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. ⋯ The current evidence base is inadequate to inform providers and policymakers about the most effective strategies for managing or allocating scarce resources during mass casualty events. Consensus on methodological standards that encompass a range of study designs is needed to guide future research and strengthen the evidence base. Evidentiary standards should be developed to promote consensus interpretations of the evidence supporting individual strategies.
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Emergency department (ED) crowding is a prevalent health delivery problem and may adversely affect the outcomes of patients requiring admission. We assess the association of ED crowding with subsequent outcomes in a general population of hospitalized patients. ⋯ Periods of high ED crowding were associated with increased inpatient mortality and modest increases in length of stay and costs for admitted patients.
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We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system. ⋯ There was 2.3-fold variation in emergency physician adjusted admission rates and 1.7-fold variation at the hospital level. In the new era of cost containment, wide variation in this common, costly decision requires further exploration.