Articles: emergency-department.
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Historical Article
Quality measurement in the emergency department: past and future.
As the United States seeks to improve the value of health care, there is an urgent need to develop quality measurement for emergency departments (EDs). EDs provide 130 million patient visits per year and are involved in half of all hospital admissions. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. ⋯ Initial priorities include measures of effective care for serious conditions that are commonly seen in EDs, such as trauma; measures of efficient use of resources, such as high-cost imaging and hospital admission; and measures of diagnostic accuracy. More research is needed to support the development of measures of care coordination and regionalization and the episode cost of ED care. Policy makers can advance quality improvement in ED care by asking ED researchers and organizations to accelerate the development of quality measures of ED care and incorporating the measures into programs that publicly report on quality of care and incentive-based payment systems.
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Clinical pediatrics · Dec 2013
Randomized Controlled TrialThe effect of a medical clown on pain during intravenous access in the pediatric emergency department: a randomized prospective pilot study.
We report the effect of the presence of a medical clown during insertion of an intravenous catheter during their emergency department visit. ⋯ Therapeutic clowns are useful for diminishing pain and anxiety during painful procedures being performed on children in the emergency department.
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Pediatric emergency care · Dec 2013
Review Case ReportsNeuroblastoma presenting as persistent postprandial emesis in a neonate.
Early identification and treatment of neuroblastoma, the most common malignant solid tumor in infants, (Atkinson et al. AJR Am J Roentgenol. 1986;146:113-117; Nuchtern. Semin Pediatr Surg. 2006;15:10-16; Lanzkowsky. ⋯ A diagnosis of nonresectable stage IV thoracoabdominal neuroblastoma with invasion to the spine was made. We concluded that oncological processes, such as neuroblastoma, should be included in the differential diagnosis of persistent emesis in the neonatal period. Emergency physicians may have the opportunity to detect neuroblastoma earlier by contemplating a broader differential diagnosis of a vomiting infant and initiating the appropriate workup in the emergency department.
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Pediatric emergency care · Dec 2013
ReviewShake, rattle, and roll: an update on pediatric seizures.
Seizure is a common presenting complaint for patients in the pediatric emergency department (PED) setting. In some cases, protocols are in place on how to manage this group of patients, for example, a patient with a simple febrile seizure already back to baseline or a patient with known epilepsy already back to baseline. However, many scenarios present dilemmas for physicians in the PED, specifically patients with status epilepticus (SE). ⋯ Current practices are constantly changing because new medications arise, and more information is gathered regarding existing medications and guidelines. Here we will review the basics about first-time afebrile seizures presenting to the PED and common treatments specific to seizure types. We will then review SE management basics and medical therapy, including both older and newer agents and their routes of administration for both the prehospital and the hospital setting.
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The heptavalent pneumococcal conjugate vaccine (PCV7) has produced a shift in the epidemiology of invasive infections from Streptoccoccus pneumoniae. ⋯ Rates of SPB have decreased since the introduction of PCV7, yet SPB still occurs among children in the ED. NVT are increasing in prevalence, and SPB from PCV7-serotypes have decreased.