Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Dyspnea is one of the most common emergency department (ED) symptoms, but early diagnosis and treatment are challenging because of multiple potential causes. Impedance cardiography (ICG) is a noninvasive method to measure hemodynamics that may assist in early ED decision making. ⋯ Impedance cardiography data result in significant changes in ED physician diagnosis and therapeutic plan during the evaluation of dyspneic patients 65 years and older.
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To determine whether suicide mortality rates for a cohort of patients seen and subsequently discharged from the ED for a suicide-related complaint were higher than for ED comparison groups. ⋯ The suicide rate among these ED patients is higher than population-based estimates. Rates among patients with suicidal ideation, overdose, or self-harm are especially high, supporting policies that mandate psychiatric interventions in all cases.
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To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences. ⋯ Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.
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Clinical practice guidelines and computerized provider order entry (CPOE) have potential for improving clinical care. Questions remain about feasibility and effectiveness of CPOE in the emergency department (ED). However, successful implementations in other settings typically incorporate decision support functions that are lacking in many commercially available ED information systems. ⋯ Adherence to an ACS guideline did not improve with implementation of a commercial ED information system without provision for patient-specific decision support. This suggests that the lack of patient-specific decision-support functionality in most current ED information system products may hamper progress in the development of effective decision support.