Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Level I trauma certification and emergency medicine resident major trauma experience.
American College of Surgeons (ACS) and Residency Review Committee for Emergency Medicine (RRC-EM) guidelines conflict regarding the role of emergency physicians in directing major trauma resuscitations. This article describes the impact of ACS level I trauma certification on emergency medicine (EM) resident trauma experience. ⋯ EM residents direct a smaller percentage of major trauma resuscitations at ACS level I hospitals than they do at non-level I facilities. This finding is not offset by an increased trauma census at level I facilities and may be more pronounced in the Northeast and the Midwest.
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To examine the effect on patient care of HMO-mandated calls for authorization prior to ED evaluation. The study examined this phenomenon prior to implementation of a California law that discourages such calls. ⋯ Calls for payment authorization prior to ED patient evaluation delay patient care and place some patients' health and safety in jeopardy.
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Multicenter Study
Community-wide emergency department visits by patients suspected of drug-seeking behavior.
To measure community-wide ED use by patients at high risk for drug-seeking behavior. ⋯ Patients identified as being at high risk for drug-seeking behavior have high community-wide ED visit rates. Improving communication between and within hospitals may help identify patients who could benefit from more consistent community-wide care and appropriate treatment for addiction.
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Comparative Study
The emergency department electrocardiogram and hospital complications in myocardial infarction patients.
To determine whether acute myocardial infarction (AMI) patients who have negative ECGs on presentation have significantly lower complication rates than do those AMI patients who have positive ECGs on presentation. ⋯ Negative- and positive-ECG AMI patients do not have moderate or large differences in the rates of in-hospital complications. Most negative-ECG patients who suffer complications evolve ECG changes prior to the event and such changes indicate the potential need for a higher level of care.