Articles: hospital-emergency-service.
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Radiographs are ordered and interpreted for immediate clinical decisions 24 hours a day by emergency physicians (EP's). The Joint Commission for Accreditation of Health Care Organizations requires that all these images be reviewed by radiologists and that there be some mechanism for quality improvement (QI) for discrepant readings. There must be a log of discrepancies and documentation of follow up activities, but this alone does not guarantee effective Q. ⋯ This system has reduced the need for the radiologist to ask or guess what the impression was in the ED the night before. It has reduced the variability in recording of impressions by EP's, in communication back from radiologists, in the clinical] follow-up made, and in the documentation of the whole QI process. This system ensures that EP's receive notification of their discrepant readings, and provides continuing education to all the EP's on interpreting images on their patients.
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Editorial Comment Review
[Use of non-invasive positive pressure ventilation for cardiogenic pulmonary edema in emergency care units].
The work reported by L'Her et al. in this issue of La Presse Médicale demonstrates the feasibility of applying simple intensive care techniques in situations frequently encountered in emergency care units. These authors used a face mask for continuous positive pressure ventilation in patients over 70 years of age admitted for respiratory distress related to cardiogenic pulmonary edema. In these elderly patients, the authors noted an improvement in blood gases, respiratory rate and heart rate and did not observe any secondary effect. ⋯ Symptomatic treatment in this type of disorder is mechanical and continuous positive airway pressure diminishes this work. Cardiogenic pulmonary edema in the elderly is thus an excellent indication for spontaneous ventilation with positive expiratory pressure. Improvement in these simple techniques, their widespread use and a better understanding of their limitations remain important challenges for the future.
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Issues regarding the deaths of patients in the ED arise on a regular basis for emergency physicians. These issues include physician discomfort with death notification, the approach to families after ED deaths, autopsies, donation of organs and tissues, and procedures on the newly dead. ⋯ Improved physician education, including the need for a death notification plan and enlistment of the support of nursing personnel, social workers, and clergy, may improve the experience of events surrounding ED deaths for physicians, families, and society. We review the literature and give recommendations on approaches to deal with these issues.
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This systematic review assesses the extent to which primary-secondary substitution is possible in the field of emergency care where the range of options for the delivery of care is increasing in the UK and elsewhere. Thirty-four studies were located which met the review inclusion criteria, covering a range of interventions. This evidence suggested that broadening access to primary care and introducing user charges or other barriers to the hospital accident and emergency (A & E) department can reduce demand for expensive secondary care, although the relative cost-effectiveness of these interventions remains unclear. ⋯ Simply transferring interventions which succeed in one setting without understanding the underlying process of change is likely to result in unexpected consequences locally. Nevertheless, the review findings clearly demonstrate that shifting the balance of care is possible. It also highlights a persistent gap in professional and lay perceptions of appropriate sources of care for minor illness and injury.