Articles: emergency-department.
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Pressure on emergency departments (EDs) sometimes results in handover delays for patients who arrive in ambulances, leading to operational disruption to the ambulance service and ED, and poorer patient experience. Some EDs have adopted models of care to provide rapid access for emergency patients to senior clinical staff. ⋯ The review suggests that rapid access models in the ED may have benefits for patients, though evidence is still limited.
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Delays to the handover of patients from ambulances to the emergency department (ED) cause operational challenges for hospitals and the ambulance service, and have attracted considerable public and policy concern. As part of a wider study of handover delays, we sought to understand the perspective of health service staff on their impact and causes, in the ED of a large teaching hospital. ⋯ Handover delays at the ED have a negative impact on patients, staff and health service organisations. System-wide impacts suggest that system-wide approaches to resolving delays are required.
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Acute bacterial skin and skin structure infections (ABSSSIs) are frequently treated in emergency departments (EDs) or observation units (OUs) initially with intravenous (IV) antibiotics before discharge on oral therapy. This study aims to describe ABSSSI patients discharged directly from EDs/OUs. ⋯ The low rate of ED revisit/hospitalization supports the use of OUs for low acuity ABSSSIs requiring initial IV therapy. Resource utilization within EDs/OUs for the management of ABSSSIs needs to be evaluated for unnecessary testing/procures.
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The aim of this study was to identify predictors of ICU transfer or death within 48 h obtainable within 4 h of admission in emergency department (ED) patients with suspected infection. ⋯ Readily available clinical and laboratory variables at arrival in the ED can support identification of late deterioration leading to ICU transfer or death within 48 h of admission.
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Increasing pressure on the emergency care system contributes to delays in patient handover from ambulances to emergency departments. The impact of these delays includes ambulance queues, sub-optimal care for patients, staffing and operational challenges, and (in England) financial penalties. New models of care have the potential to reduce handover delay. We surveyed ambulance services across England and Wales to produce a snapshot of initiatives under development or being trialled in order to address problems associated with handover delay. ⋯ While there is a range of activity taking place across England and Wales to address handover delays, there is little formal evaluation and there are missed opportunities for transferable learning.