Articles: hospital-emergency-service.
-
Clinical cardiology · Aug 1999
ReviewChest pain emergency centers: improving acute myocardial infarction care.
Uncertainty and delay are common in the diagnosis of acute coronary syndromes (ACS). In the last 20 years, the need for faster, more accurate, and more cost-effective diagnosis gave rise to the concept of specialized treatment of patients with chest pain in emergency departments (EDs). The original strategy dedicated a separate section of the ED and a nursing staff to the task of rapid intervention in patients with acute myocardial infarction (MI) and triage of low-risk patients. ⋯ There existing centers--the University of Cincinnati Heart ER, Brigham and Women's Hospital, and the Medical College of Virginia--have implemented chest pain strategies with the common aims of (1) screening for the entire spectrum of coronary artery disease, (2) avoiding unnecessary admissions, and (3) using multiple diagnostic modalities. Yet, they differ in the specifics of their approaches and diagnostic methods (e.g., echocardiography vs. treadmill vs. myocardial perfusion imaging). The safety and cost effectiveness of these centers are discussed.
-
The appropriateness of Emergency Department (ED) usage is often questioned, with recognition at an international level of the growing prevalence of 'inappropriate attenders'. This term is used to describe individuals who present for treatment that could more appropriately be provided in the primary health care setting. ⋯ The present article offers a review of currently identified issues concerning ED attendance, and examines the core question of the role of primary care in the Emergency Department. It asks whether this is an appropriate use of ED resources, and if so, what are the implications for the role of the emergency nurse?
-
From the published evidence there is no doubt that emergency physicians in America can undertake focused ultrasound examinations and that, by extrapolation, this would also be the case for UK emergency physicians. If this skill is to become part of the diagnostic armamentarium of the emergency physician, however, it needs to be demonstrated to be cost effective compared with the alternatives already available to the hospital. Trials to test for this benefit should adopt a hospital and not an emergency department perspective if the results are to influence health policy and specialty training.