The American journal of emergency medicine
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There has been increasing awareness concerning the problem of acute pain in ED patients. There has, however, been little attention devoted to chronic pain in ED patients. Our purpose was to determine the extent and severity of chronic pain in adult ED patients. ⋯ They are high users of ED services and most have not been seen in a pain clinic. Further studies are indicated to further delineate the demographics of this population and determine which patients would best be served in other healthcare settings. In an effort to improve care, ED physicians should be educated in diagnosing and treating chronic pain.
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This study's purpose was to identify risk factors for return and admission within 72 hours of discharge from the emergency department (ED). During a 2-year period, 104,584 patients were seen and discharged in the ED, and 493 (0.47%) patients returned within 72 hours requiring admission. Risk factors compared were age, sex, race, insurance status, and initial diagnosis. ⋯ The highest risk initial diagnosis categories were mental disorder (1.2%), genitourinary system (0.93%), and symptom-based diagnoses (0.76%). Also, a high proportion of patients arrived by ambulance. Patients at increased risk of early admission can be identified and should be the first target for prospective prevention strategies that seek to minimize high-risk early returns to the ED.
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Point of care testing (POCT) is widely viewed as possibly improving ED care and reducing length of stay (LOS). However reports are mixed, and regulatory barriers complicate considerations. We studied a simple urine pregnancy assay (human chorionic gonadotropin-HCG). ⋯ Staff (28/53 physicians, 18/81 nurses) reported HCGED as positive. POCT does not improve LOS for broad groups of patients, although POCT does change the ED environment. Further study is needed to evaluate how the information flow of POCT changes patient care.
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Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. The SARS outbreak in Singapore started in mid-March 2003. ⋯ This report discusses the changes in the Department of Emergency Medicine at Singapore General Hospital, the largest public, teaching and tertiary hospital in Singapore, during this outbreak. It will highlight the safety aspects and universal precautions undertaken, the changes to the triage system, working hours, admission policies, as well as the fluctuations in the patient load.