European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Appropriate use of laboratory test requests in the emergency department: a multilevel intervention.
Laboratory test requests in the emergency department (ED) are increasing worldwide. We evaluated whether a multilevel intervention on the basis of the optimization of test profiles and educational meetings with physicians could reduce the number of tests ordered. ⋯ Optimization of test profiles and education on the costs and appropriate use of the tests significantly reduced laboratory test ordering and costs without affecting ED and laboratory performances.
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Observational Study
Trendelenburg position in the ED: many critically ill patients in the emergency department do not tolerate the Trendelenburg position.
Critically ill patients in emergency departments (ED) frequently require catheterization of the internal jugular vein. For jugular insertion, the Trendelenburg position (TP) is recommended. However, many patients in the ED do not tolerate lying in the supine or even the head-down position, or TP is contraindicated for other reasons. The aim of our trial was to investigate to which extent TP is either not tolerated or contraindicated in the target population of patients admitted to the ED. ⋯ For central venous catheterization, TP remains the gold standard. Our trial shows the limitations of this positioning for critically ill patients. Almost 40% of the patients could not be tilted 15° head-down. Therefore, guideline recommendations should be reconsidered and alternatives should be sought.