The American journal of emergency medicine
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Comparative Study
Effect on efficiency and cost-effectiveness when an observation unit is managed as a closed unit vs an open unit.
To compare efficiency and cost-effectiveness of an observation unit (OU) when managed as a closed unit vs an open unit. ⋯ The same OU was more efficient and cost-effective when managed as a closed unit vs an open unit.
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Health care costs continue to rise; reducing unnecessary laboratory testing may reduce costs. The goal of this study was to calculate the frequency and estimated costs of repeat normal laboratory testing of patients transferred to a tertiary care emergency department (ED). ⋯ This study provides the first analysis of the frequency of repeated laboratory testing for all transferred ED patients and indicates that repeat normal testing represents a significant cost. Future research needs to determine if such repeat testing is indeed clinically appropriate or redundant.
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This study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT). ⋯ Age, dark urine, etiologies, serum levels of blood urea nitrogen, creatinine and potassium, and initial and peak serum myoglobin levels may serve as important factors in predicting ARF in patients with rhabdomyolysis. We suggest that the appropriate cutoff value of initial serum myoglobin for predicting ARF is 600 ng/mL.
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Operational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility of data errors, but the frequency and magnitude of transient errors during this fast-evolving systems upheaval are unknown. This study was done to assess operational data quality in an emergency department (ED) immediately before and after an EHR implementation. ⋯ This single-center study raises questions about operational data quality in the peri-implementation period of EHRs. Using electronic timestamps for operational assessment and decision making following implementation should recognize the magnitude and compounding of errors when computing service times.
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The major symptoms of median arcuate ligament syndrome, celiac axis stenosis, or occlusion compressed by the median arcuate ligament include eating-associated abdominal pain and weight loss. Because celiac stenosis increases retrograde collateral blood flow from the superior mesenteric artery to the celiac artery via the pancreaticoduodenal arcade, a pancreaticoduodenal artery aneurysm could occur at a low incidence rate. Rupture of the pancreaticoduodenal artery aneurysm and hemorrhagic shock are rare. ⋯ Case 1 demonstrated severe hemorrhagic shock, whereas case 2 demonstrated moderate shock. We treated ruptured pancreaticoduodenal artery aneurysms with coil embolization. Case 3 demonstrated complete celiac occlusion and moderate hemorrhagic shock, and no aneurysm was detected.