Annals of emergency medicine
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Randomized Controlled Trial Pragmatic Clinical Trial
A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department.
Emergency department (ED) crowding is a common and complicated problem challenging EDs worldwide. Nurse-initiated protocols, diagnostics, or treatments implemented by nurses before patients are treated by a physician or nurse practitioner have been suggested as a potential strategy to improve patient flow. ⋯ Targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay. A cooperative and collaborative interdisciplinary group is essential to success.
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Despite focus during the past decade about the need to design a more patient-centered US health care system, patients have been minimally engaged to define what they want from it. Our objective is to engage patients to identify individual-defined priority outcomes on discharge from the emergency department (ED) and individually tailored interventions to help achieve their outcomes. ⋯ Many patients have ongoing needs that are often not addressed during ED discharge. These needs are based on ongoing uncertainty about the cause of their symptoms and what to expect, and result in feelings of fear. Work is needed to develop approaches to alleviate patient fear and uncertainty and to equip providers with the capabilities and resources needed to adequately address these needs.
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Randomized Controlled Trial Comparative Study
Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial.
We determine whether emergency physician-provided deep sedation with 1:1 ketofol versus propofol results in fewer adverse respiratory events requiring physician intervention when used for procedural sedation and analgesia. ⋯ Ketofol and propofol resulted in a similar incidence of adverse respiratory events requiring the intervention of the sedating physician. Although propofol resulted in more hypotension, the clinical relevance of this is questionable, and both agents are associated with high levels of patient satisfaction.
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Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. ⋯ Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law.