Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Case Reports
Social-work services in an emergency department: an integral part of the health care safety net.
To quantify and describe the activities of social workers dedicated to a large urban emergency department (ED). ⋯ Social workers provide valuable services to ED patients. The availability of social workers in the ED reduces the demands for emergency physicians and nurses to arrange home health care, nursing home placement, and other social-service functions. Cost savings through diversion of nonacute social admissions are possible. The types of services provided vary and depend to a large extent on patient age. The availability of dedicated social-work personnel in the ED and the education of emergency personnel regarding the services that they can provide should be beneficial for patients, staff, and the hospital served.
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Editorial Comment
Triage of nonurgent patients out of the emergency department.
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To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. ⋯ The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.
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To define risk factors for infections from dog- bite wounds and to model the probability of wound infection in patients presenting without infection who are treated as outpatients. ⋯ A low wound infection rate was seen in this cohort of dog-bite victims who were treated on an outpatient basis. Wound depth, patient gender, and wound debridement were the clinical variables that best predicted the likelihood of developing infection. Future interventional studies should concentrate on wounds with high probabilities of infection.
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Associate statewide trauma system development with a change in the percentage of injured patients initially hospitalized at Levels I and II categorized trauma hospitals and a change in the length of stay (LOS) prior to arrival at a Level I or II hospital (PRE-LOS) and total LOS (T-LOS) for post-admission transfer patients. ⋯ In Oregon, development of a statewide trauma system was associated with increased initial admissions to Level I and II trauma hospitals. For those patients transferred to higher levels of care post- admission, hospital LOSs were decreased with trauma system development.