The American journal of emergency medicine
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This study's objectives were to determine the cost-effectiveness of introducing a transcription service into an emergency department (ED) and to determine the capacity of such a service to improve physician satisfaction. A prospective study of full-time emergency physicians was conducted in the ED of a community hospital in which a transcription service was introduced during peak periods of demand. Measurement was defined from a time-and-motion study consisting of direct observation by an industrial engineer who measured documentation time required for written and dictated charts. ⋯ When the records were transcribed, the mean subjective scores for satisfaction with the medical record improved from 2.1 to 3.6 (P = .0025) on a scale of 1 to 4. Surveys of nonemergency staff physicians documented that legibility score improved from 2.6 to 3.1 (P = .0056) and completeness improved from 2.6 to 3.0 (P = .0157), both on a scale of 1 to 4. It was concluded that dictating and transcribing ED medical records decreases the time required for documentation, improves record legibility and quality, allows more patients to be seen per physician-hour, and improves the satisfaction of emergency and nonemergency physicians.
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Letter Case Reports
Bowel obstruction and radiopaque vitamin B12 "pseudobezoar".
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Comparative Study
Comparison of pediatric end-tidal CO2 measured with nasal/oral cannula circuit and capillary PCO2.
This study was designed to determine whether end-tidal carbon dioxide (ETCO2) values obtained by noninvasive oral/nasal cannula circuit with side-stream capnometry correlate reliably with capillary PCO2 (CapCO2) in a pediatric population without cardiopulmonary problems. Each patient was monitored until a reliable 5-minute ETCO2 waveform was obtained. A capillary blood gas sample was drawn while, simultaneously, ETCO2 was recorded. ⋯ A relative average bias of 1.96 with ETCO2 lower than CapCO2 was established with 95% limits of agreement of +/- 5.2 mm Hg (t = 5.71). Variability of difference scores was not related to range of mean scores (r = .08), age (r = .09), or respiratory rate (r = .25). End-tidal CO2 measured by an oral/nasal cannula capnometry circuit is a noninvasive method of assessing indirect measurements of PCO2 in a normal pediatric population.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cost analysis of stapling versus suturing for skin closure.
A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. ⋯ The average total cost per case was $17.69 (with suture kit) and $7.84 (without suture kit) for the staple Group compared with $21.58 for the suture Group (P = .0001 for each). It is concluded that stapling is less costly than suturing and that the advantage appears to increase as laceration length increases.