Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
Evaluating Emergency Nurse Practitioner Service Effectiveness on Achieving Timely Analgesia: A Pragmatic Randomized Controlled Trial.
The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. ⋯ Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.
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Computed tomography (CT) utilization has increased rapidly over the past 15 years. CT is the most common source for radiation exposure. ⋯ The amount of radiation delivered to pediatric patients during routine CT examinations of the head and abdomen was low. Regardless, a large proportion of older patients were exposed to elevated effective doses of radiation during abdominal CT.
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The Joint Commission Comprehensive Stroke Center certification requires that magnetic resonance imaging (MRI) be available on site, 24 hours a day, 7 days a week for evaluation of stroke in emergency department (ED) patients. Increased access to advanced diagnostic imaging has been shown to increase utilization, ED length of stay (LOS), and health care costs. EDs nationwide face decisions to pursue certification and increase MRI access. Understanding changes in utilization and the downstream effects may inform these decisions. ⋯ Emergency MRI utilization increased substantially after placement of a fully accessible MRI in the ED. Patients receiving emergency MRI had increased ED LOS, decreased admission rates for some patients (rule-out stroke), and reduced hospital LOS for those admitted. Potential changes in ED patient resource utilization should be considered when determining whether to acquire an MRI for Comprehensive Stroke Center certification.