Articles: hospital-emergency-service.
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To develop and internally validate a multivariable logistic regression model (LRM) for the prediction of the probability of 1-year readmission to the emergency department (ED) in patients with acute alcohol intoxication (AAI). We developed and internally validated the LRM on a previously analyzed retrospective cohort of 3304 patients with AAI admitted to the ED of the Sant'Orsola-Malpighi Hospital (Bologna, Italy). The benchmark LRM employed readmission to the same ED for AAI within 1 year as the binary outcome, age as a continuous predictor, and sex, alcohol use disorder, substance use disorder, at least one previous admission for trauma, mental or behavioral disease, and homelessness as the binary predictors. ⋯ The reduced LRM had the following optimism-corrected metrics: scaled Brier score 17.0%, C-statistic 0.799 (95% CI 0.778 to 0.821), calibration in the large 0.000 (95% CI - 0.099 to 0.099), calibration slope 0.985 (95% CI 0.893 to 1.088), and an acceptably accurate calibration plot. An LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness can be used to estimate the probability of 1-year readmission to ED for AAI. To begin proving its clinical utility, this LRM should be validated in external cohorts.
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Emerg Med Australas · Apr 2024
Evaluating the use of clinical decision aids in an Australian emergency department: A cross-sectional survey.
To identify healthcare professionals' knowledge, self-reported use, and documentation of clinical decision aids (CDAs) in a large ED in Australia, to identify behavioural determinants influencing the use of CDAs, and healthcare professionals preferences for integrating CDAs into the electronic medical record (EMR) system. ⋯ CDAs are used variably by healthcare professionals and are inconsistently applied in the clinical encounter. Preferences of healthcare professionals need to be considered to allow the successful integration of CDAs into the EMR.
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Observational Study
Emergency department use of an electronic differential diagnosis generator in the evaluation of critically ill patients.
Accurate diagnosis is an essential component of managing critically ill emergency department (ED) patients. Electronic diagnosis generators (EDGs) are software tools which assist clinicians in their diagnosis generation; however, they have not been evaluated for use for critical ED patients. We aimed to evaluate the use of an EDG for this population to determine its impact on diagnosis generation and diagnostic testing. ⋯ EDGs have some potential to improve diagnosis in critical EM patients by expanding the differential diagnosis and, to a lesser extent, altering diagnostic testing.
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Academic medical centers must balance caring for patients in their community with their role as referral centers for more profitable tertiary quaternary (T/Q) care. Hospital medicine services, which admit patients largely from the emergency department, often have the lowest proportion of T/Q care and may thus be under pressure to demonstrate their value to the health system. Looking at the 5771 patients that were discharged from our hospital medicine service between 2021 and 2022, we found that three quarters (74.6%) of patients had at least one prior outpatient encounter at our institution, and that more than a third (36.1%) were established patients in departments of strategic importance to our institution. Our study provides a framework for academic hospital medicine services looking to assess their patient population's connection with the broader health system and suggests that our hospital medicine service provides inpatient care to a population critical to the role of the institution in our community both locally and regionally.
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To understand factors that contribute to variation in time to abdominal and/or pelvic ultrasound in pediatric patients in an emergency department (ED) by utilizing rational subgrouping to assess opportunity for improvement. ⋯ Longer time to study completion was observed in female patients, older patients, and during night shifts. Use of rational subgrouping supported understanding of variation among subgroups of patients evaluated with abdominal and/or pelvic ultrasound. This allowed informed decision-making regarding opportunities for improvement. Rational subgrouping is a useful methodology in planning QI initiatives as it identifies sources of variation within a nonhomogeneous population and allows for judicious decision-making in a context of limited resources.