J Emerg Med
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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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We present the case of a patient with profound alcohol-related lactic acidosis (lactate = 16.1 mmol/L; pH = 6.67) associated with a multitude of metabolic derangements who made a remarkable recovery following aggressive management. The patient was in extremis upon arrival in the emergency department (ED), and resuscitation was begun immediately. ⋯ In this patient, the severe lactic acidosis and associated abnormalities were all attributed to acute and chronic effects of ethanol. A brief summary of the proposed mechanism by which these metabolic derangements developed and an outline of her management follows.
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Numerous studies have shown the futility of continued emergency department (ED) resuscitative efforts for victims of out-of hospital cardiac arrest when prehospital resuscitation has failed. Nevertheless, these patients continue to arrive in the ED, where they create a strain on resources. To assess the economic cost of this, Medicare expenditures were determined for resuscitative efforts on victims of atraumatic, out-of-hospital cardiac arrest subsequently pronounced dead in the ED. ⋯ Failed out-of-hospital resuscitation for Medicare patients is associated with poor outcome and high cost. Termination of these efforts in the prehospital arena is unlikely to affect outcome, and would result in considerable cost savings on physician and hospital facility charges. Compassionate protocols that recognize these principles should be developed and implemented.