Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Pneumonia hospitalization rates are frequently reported as a measure of pneumonia disease burden in the United States. However, a detailed understanding of pneumonia burden in all health care settings, including the emergency department (ED), is essential for measuring the full effect of this disease on the population and planning and evaluating interventions to reduce pneumonia-related morbidity. The aim of this study was to quantify pneumonia-attributable ED visits in the United States among children and adults during the 3-year period July 2006 through June 2009. ⋯ Pneumonia accounts for 2.2% of ED visits in the United States and results in approximately seven to eight ED visits per 1000 persons per year. A substantial proportion of pneumonia cases diagnosed in the ED are managed in treat-and-release ED outpatient visits, highlighting that enumeration of ED visit rates provides important complementary information to hospitalization rates for the assessment of pneumonia burden.
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The objective was to identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield (BCBS) of Massachusetts in 2009, on emergency department (ED) presentations. ⋯ In the first year of this AQC, we did not find evidence of change in aggregate ED use. Similar global budget programs may not alter ED use in the initial implementation period.
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The authors sought to describe the demographic and clinical characteristics of interhospital transfers from U.S. emergency departments (EDs) along with the primary reasons for transfers. ⋯ Transfer of ED patients was relatively rare, but was more common among specific, potentially high-risk populations. Diagnostic testing, including advanced imaging, was common prior to transfer. A majority of transfers were for reasons indicating limited resources or expertise at the referring facility.
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As residents, we constantly strive to independently manage our patients and develop care plans, while the role of the attending faculty varies between complete supervision and control, to allowing complete autonomy. This concept of attending physicians allowing appropriate autonomy so that residents can develop independence in their practice has been termed entrustment. Patients' and instructors' entrustment of responsibility reflects upon one's preparedness to assume professional responsibility after graduation. ⋯ Some experiences have been incredible as we develop our styles of practice, while others have been incredibly frustrating and soured the learning environment. As third-year residents, we studied the factors that allow faculty to foster an appropriate amount of entrustment and conducted discussions with multiple residents on this topic. We have found several themes of how this can be done well and share these ideas with a goal of improving autonomy for emergency medicine residents.