Articles: emergency-department.
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Pediatric emergency care · Oct 2014
Comparative StudyChanges in practice patterns with the opening of a dedicated pediatric emergency department.
Dedicated pediatric emergency departments (ED) staffed by pediatric emergency medicine physicians are becoming more common. We compared processes of care and outcomes before and after opening a dedicated pediatric ED. ⋯ Opening of a pediatric ED with pediatric emergency physicians was associated with decreases in ED LOS, rates of LWBS, general radiographic, and computed tomography imaging as well as laboratory testing, and increases in patient satisfaction scores. The clinical significance of these changes is unclear.
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Pediatric emergency care · Oct 2014
Prevalence of serious bacterial infections in return visits to the emergency department among infants aged 90 days or younger.
The main objective of this study was to describe the epidemiology of return visits (RVs) in well-appearing infants to an urban emergency department (ED) who were evaluated for serious bacterial infection (SBI) at their index ED visit. ⋯ Infants aged 90 days or younger who are evaluated for SBI have high RV rates. A substantial number of RVs are due to contaminated blood cultures. Future studies should be conducted to identify predictors for false-positive blood cultures.
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Sepsis is a serious condition with high mortality. Early treatment improves outcome and can be initiated by emergency medical services (EMS) personnel.The primary aim of our study was to investigate how many sepsis patients are transported by EMS to the internist at the emergency department (ED). The secondary aims were to compare these EMS patients with patients who arrived at the ED otherwise and to investigate how these patients were managed. We further investigated how often the diagnosis sepsis/infection was documented by EMS. ⋯ Half of the patients with sepsis arrive at the ED by EMS. These patients are seriously ill, and although these patients are likely to benefit from early treatment, they are often transported with nonurgent rides and both assessment of vital signs and early start of treatment are not routinely performed.
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Catatonia was first described by a German psychiatrist, Karl Kahlbaum, in 1874. It is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying general medical and psychiatric disorders. A wide variety of neurologic, metabolic, drug-induced, and psychiatric causes of catatonia have been reported. ⋯ After extensive emergency department testing, including negative computed tomography head, negative magnetic resonance imaging brain, negative electroencephalogram, and normal laboratory results, the patient was diagnosed with new-onset bipolar disorder with depressive features presenting as catatonia. Recognizing catatonia is important because it may be caused or exacerbated by treatment of the underlying disorder. Failure to institute treatment early in the course of catatonia is associated with a poor prognosis.
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Performance of percutaneous coronary intervention (PCI) within 90 minutes of hospital arrival for ST-segment elevation myocardial infarction patients is a commonly cited clinical quality measure. The Centers for Medicare and Medicaid Services use this measure to adjust hospital reimbursement via the Value-Based Purchasing Program. This study investigated the relationship between hospital performance on this quality measure and emergency department (ED) operational efficiency. ⋯ Better performance on measures associated with ED efficiency is associated with more timely PCI performance.