Articles: emergency-department.
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Emergency department (ED) crowding negatively affects quality of care and disproportionately affects medium-acuity (Emergency Severity Index [ESI] level 3) patients. The effect of a dedicated area in the ED focused on these patients has not been well studied. ⋯ Implementation of a midtrack area dedicated to caring for uncomplicated medium-acuity (ESI 3) patients was associated with a decrease in overall ED LWBS rates and ED LOS for medium-acuity patients.
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In emergency departments (EDs), overcrowding, workload complexity, and cost containment represent current operational problems. In this retrospective observational study, we analyzed the effects of a professional quality management (QM) system on patient flow, diagnostic validity, and hospital costs. ⋯ The introduction of a professional QM system in EDs improves patient flow as well as quality of medical care and results in a significant reduction in hospital costs. Further analyses should evaluate the effects of QM on quality indicators in a prospective multicenter study. Validation of results has to be performed in a dynamic model for process simulation.
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Randomized Controlled Trial
Topical Tetracaine Used for 24 Hours Is Safe and Rated Highly Effective by Patients for the Treatment of Pain Caused by Corneal Abrasions: A Double-blind, Randomized Clinical Trial.
The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for 24 hours and would not affect corneal healing, that patients would experience more pain relief, and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions. ⋯ Topical tetracaine used for 24 hours is safe, and while there was no significant difference in patient VAS pain ratings over time, patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline.
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The objective was to compare the first-pass success and clinical performance characteristics of the reusable standard GlideScope® video laryngoscope (sGVL) and the disposable Cobalt GlideScope® video laryngoscope (cGVL). ⋯ In this observational study, the sGVL had higher first pass and overall success than the disposable cGVL. The cGVL had significantly higher incidence of lens fogging and contamination, which may partially account for its lower success. A prospective randomized trial is needed to confirm these findings.
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Multicenter Study Comparative Study Clinical Trial
Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study.
Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for preventative interventions. Previous studies have used single-country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context. ⋯ Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.