The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
A simple strategy for improving patient contact after ED discharge.
The purpose of this study was to assess strategies to improve telephone contact with adult patients discharged from the emergency department (ED). The basic procedure was a prospective, randomized, interventional trial of a convenience sample of patients 18 years or older being discharged from the ED. Patients were excluded if they had altered mental status or were unable to communicate with the College Research Associates (RAs). ⋯ There were no significant demographic differences between the 2 groups. Forty-seven (54%) control subjects were contacted versus 58 (77%) in the intervention group (P <.003; Chi-square test). A simple patient interview conducted immediately before discharge confirming the patient's telephone number and setting a time for a follow-up call significantly improved patient follow-up contact rates.
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Early recognition of inpatient bed requirements might be helpful in expediting the admission process through the emergency department (ED). With this in mind, we asked whether ED triage nurses could accurately predict patients' in-hospital dispositions. ⋯ With respect to predicting specific levels of inpatient care, nurses correctly anticipated 17 of 45 floor admissions (sensitivity = 37.8%, PPV = 34.7%), 14 of 33 step-down/monitored unit admissions (sensitivity = 42.4%, PPV = 48.3%), and 12 of 24 intensive care unit admissions (sensitivity = 50.0%, PPV = 66.7%). Lacking in sensitivity and positive predictive value, particularly with regard to specific levels of inpatient care, triage nurses' predictions may have limited potential to expedite the admission process.
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Lisfranc fracture-dislocation of the foot is an injury that carries a high incidence of chronic pain and disability. Its emergency department presentation can be subtle, and more frequent than previously believed. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner.
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Comparative Study
Drug screening versus history in detection of substance use in ED psychiatric patients.
Because self-reporting of substance use may not be reliable, physicians rely on drug screening. We tested the hypothesis that drug screening alone is sufficient to detect substance use in ED psychiatric patients. We prospectively evaluated patients receiving psychiatric consultation over 6 months ending in April 1998 in an urban medical/psychiatric ED with 42,000 annual visits. ⋯ Drug testing alone was never significantly better than history. Although self-reporting of substance use is not reliable, reliance on drug screening alone is also flawed. Optimal identification of drug use in emergency department psychiatric patients requires both history and drug screening.
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The objective of this study was to investigate the outcome and rate of symptomatic recurrence of paroxysmal supraventricular tachycardia (PSVT) in an emergency department (ED) patient population, after ED management and disposition. A retrospective descriptive review of ED records and state death registry was performed. The study took place at a University hospital ED with 60,000 annual patient volume. ⋯ Most patients with PSVT can be safely discharged from the ED after short-term observation if therapy produces prompt conversion to NSR. PSVT recurrence is relatively uncommon and usually occurs within 24 hours of ED presentation. PSVT recurrence occurs more often in the elderly and in those with established cardiac disease.