J Emerg Med
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This retrospective study was designed to investigate the current practice of nasotracheal intubation (NTI) in the Emergency Department (ED) at the University of California, San Diego Medical Center. Over a 5-year period, 21% (105/501) of patients intubated in the ED had at least one NTI attempt. The most frequent primary diagnoses in these patients included drug overdose, congestive heart failure, and chronic obstructive pulmonary disease. ⋯ Thus, there is limited exposure to this intubation technique in EM residency programs. Nasotracheal intubation is a useful alternative to oral intubation, particularly when oral access is compromised. While not the optimal approach, we conclude that NTI is still a valuable method for establishing an airway and should remain among the emergency physician's arsenal of intubation techniques.
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Comparative Study Clinical Trial
Serial use of bedside CKMB/myoglobin device to detect acute myocardial infarction in emergency department chest pain patients.
A qualitative bedside device (Spectral Diagnostics, Toronto, Canada) for CKMB and myoglobin (MYOG) detection was evaluated in emergency department (ED) patients with chest pain to determine performance characteristics. At presentation (0 h) and at three hours (3 h), serum was analyzed in the ED with results considered positive if either 0-h or 3-h CKMB or MYOG bands were visible. The results were compared with the diagnosis of myocardial infarction (MI) per hospital discharge diagnosis (n = 132, 87%) or telephone follow-up (n = 19; 1 patient lost to follow-up). ⋯ If the device result was positive, then the odds ratio for having an ischemic complication was 6.5. We conclude that the CKMB/MYOG device identified most MI patients at ED presentation and 3 h later. Combining device results with EKG detected all MI patients in the ED.
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Randomized Controlled Trial Clinical Trial
Effect of point of care testing on length of stay in an adult emergency department.
Devices are now available that are practical for point of care testing (PCT) in hospital settings. Previous studies in clinical settings, however, have failed to demonstrate a reduction in patients' length of stay (LOS) associated with the use of PCT. This randomized controlled study compared PCT with central laboratory testing in a hospital Emergency Department to assess the difference in patients' LOS. ⋯ The median stay associated with PCT was significantly shorter. Among patients who were destined to be discharged home, there was also a significantly shorter stay, but not among those who were destined to be admitted. It was concluded that the use of PCT can achieve significant time savings in an Emergency Department.
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Comparative Study
Time analysis of consult service emergency department admission process compared with emergency medicine service admission process.
This prospective case-controlled study was performed to compare the time intervals of a consult emergency department (ED) admission process with an emergency medicine (EM) service admission process. During March 1994, the consultant services admitted 307 patients for hospitalization at an urban tertiary academic ED with an EM residency; in April 1994, the EM service admitted 264 patients. The times measured were: 1) triage to examination room; 2) room to first physician contact; and 3) emergency physician contact to admit request. ⋯ Concordance of the ED admitting impression and the hospital discharge diagnosis was 99% (259/264). We conclude that in selected tertiary academic EDs, admission of all patients by the EM service is more efficient than a consultant-admission process. Outcomes show the EM admission process may be employed safely and with accurate patient diagnosis.
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Randomized Controlled Trial Clinical Trial
Prescription noncompliance: contribution to emergency department visits and cost.
We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. ⋯ Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year's medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.