Articles: emergency-department.
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Comparative Study
Emergency department (ED) utilization by HIV-infected ED patients in the United States in 2009 and 2010 - a national estimation.
The aim of the study was to describe the emergency department (ED) resource utilization patterns of ED visits by patients reported to be HIV-infected in the USA in 2009 and 2010 and to compare them with those of the general ED patient population. ⋯ ED visits by HIV-infected individuals occur at rates higher than those of visits by the general population, and consume significantly more ED resources than visits by the general population. These national findings represent baseline prior to full implementation of the 2010 Patient Protection and Affordable Care Act.
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Review Meta Analysis
The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis.
Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED. ⋯ The quality of the overall literature base for mesenteric ischemia is varied. Signs, symptoms, and laboratory testing are insufficiently diagnostic for the condition. Only CT angiography had adequate accuracy to establish the diagnosis of acute mesenteric ischemia in lieu of laparotomy.
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Pediatric patients, who accounted for 17.4% of US emergency department (ED) visits in 2010, present unique challenges that can impede an ED's ability to provide optimal care. To meet the growing demand for comprehensive, high-quality care, health care systems are incorporating quality improvement (QI) methods to reduce costs and variations in care and to improve access, safety, and ultimately the outcomes of medical care. This overview of QI initiatives within the field of pediatric emergency medicine explores how proven QI strategies are being integrated into efforts that target the care of children within the broader emergency care community. ⋯ Professional societies supporting education, such as the American Academy of Pediatrics, have made several strides to cultivate new health leaders that will use QI methodology to improve outcomes in pediatric emergency care. In addition to educational pursuits, professional societies and QI organizations (eg, Children's Hospital Association) offer stable infrastructures from which QI initiatives, either disease specific or broadly targeted, can be implemented as large-scale QI initiatives (eg, quality collaboratives). This overview also provides examples of how QI methodology has been integrated into research strategies and describes how the pediatric emergency medicine community can spread innovation and best practices into the larger emergency care community.
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Previous research indicates that patients have difficulty understanding ED discharge instructions; these findings have important implications for adherence and outcomes. The objective of this study was to obtain direct patient input to inform specific revisions to discharge documents created through a literacy-guided approach and to identify common themes within patient feedback that can serve as a framework for the creation of discharge documents in the future. ⋯ Patient input provides meaningful guidance in the development of diagnosis-specific discharge instructions. Several themes and patterns were identified, with broad significance for the design of ED discharge instructions.