Articles: hospital-emergency-service.
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A coordinated approach to quality assurance is essential for managing the complexities of health care in the emergency department. Nearly every activity in the emergency care setting has implications that fall under the quality assurance umbrella. ⋯ The program follows traditional quality assurance concepts for monitoring structure, process, and outcome elements of emergency care. Key principles that are the foundation of the program include active participation by all staff levels (clinical and nonclinical), standardized documentation, and specifically defined review mechanisms.
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Comparative Study
The role of an emergency department observation unit in the management of trauma patients.
During a 12-month period, 20,838 patients with acute traumatic injuries were seen in the Emergency Department (ED) of Denver General Hospital. Of these patients, 520 (2.5%) were admitted to the ED Observation Unit, a seven-bed acute care unit situated within the ED and sufficient data were available on 485 (93%) for inclusion into the study. Fifty-three (15.4%) of these observation unit patients required subsequent admission, 389 (80%) were discharged, and 16 (4%) left against medical advice. ⋯ These groups of patients were analyzed and compared with regard to severity of injury, length of stay, and discharge diagnosis. The observation unit is useful in the evaluation of blunt chest or abdominal trauma when work-up, including chest x-ray studies and peritoneal lavage, is initially negative and when drug or alcohol ingestion obscures the initial evaluation in the ED. An observation unit within the ED is cost-efficient and has proven very useful in the management of trauma victims.
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The resuscitation of the severely injured in the accident and emergency department--a medical audit.
An audit of the medical care of the severely injured was conducted in the Accident and Emergency Department of the Royal Victoria Hospital, Belfast. Over a 6-month period the management of all patients admitted with an Injury Severity Score of 16 or over was critically assessed. ⋯ They were mainly related to the fact that 78 per cent of the patients arrived outside normal office hours when only inexperienced junior doctors staffed the department. The findings have drawn our attention to the need for both altering staffing arrangements and improving training in our department.