Articles: emergency-department.
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We applied three electronic triggers to study frequency and contributory factors of missed opportunities for improving diagnosis (MOIDs) in pediatric emergency departments (EDs): return visits within 10 days resulting in admission (Trigger 1), care escalation within 24 h of ED presentation (Trigger 2), and death within 24 h of ED visit (Trigger 3). ⋯ Using electronic triggers with selective record review is an effective process to screen for harmful diagnostic errors in EDs: detailed review of 5% of charts revealed MOIDs in half, of which half were harmful to the patient. With further refining, triggers can be used as effective patient safety tools to monitor diagnostic quality.
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Observational Study
Navigating Emergency Management of Cancer Patients: A Retrospective Study on First-Time, End-Stage, and Other Established Diagnoses in a High Turnover Emergency County Hospital.
Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data are available about emergency care's role in treating patients with cancer. This study aims to determine the burden of end-stage and first-time diagnosis of cancer on emergency care in a high-turnover emergency care center. ⋯ First-time diagnosed patients had a significantly different distribution of cancer types (p < 0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12-3.32; p < 0.001; OR 3.28, 95% CI: 2.48-4.35, p < 0.001; OR 2.09, 95% CI: 1.70-2.59; p < 0.001, respectively) but were less severe, while end-stage patients were more likely to address repeatedly to the emergency room (OR 1.86, 95% CI: 1.32-2.59; p = 0.001) and had higher odds of needing intensive care, assisted ventilation and death (OR-4.63, 95% CI: 1.10-19.45, p = 0.04; OR 2.59, 95% CI: 1.57-4.28; p < 0.001, and OR 4.06, 95% CI: 1.73-9.54; p = 0.001, respectively). Conclusions: The emergency department often carries the weight of diagnosing patients with cancer and treating patients with end-stage disease. These data highlight the importance of prehospital care, particularly for cancer screening and palliative care, and the importance of fostering multidisciplinary collaboration in the emergency room with oncologists, geriatricians, and palliative care specialists to improve patient outcomes.
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The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness. ⋯ This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness.
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This study aimed to determine the tendency of older adults to present to the emergency department with pain complaints during the COVID-19 pandemic compared to the prepandemic period. ⋯ During the COVID-19 pandemic, our study revealed fewer presentations to the emergency department for pain-related complaints. To prevent severe health problems from delayed care, we recommend expanding telemedicine, remote pain management, and home-based care. Further research is needed to examine the long-term effects of increased myalgia and joint pain.
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Take home naloxone kits can reduce mortality, but we know little about how they are perceived by people with lived experience of opioid use. Provision of naloxone in the community has been shown to significantly reduce mortality from opioid overdose. Currently, this is predominantly through drug treatment support services but expanding provision through other services might be effective in increasing kit take-up and mortality reduction. This study aimed to examine participants' experiences of opiate overdose and acceptability of provision of naloxone kits through ambulance/paramedic emergency services (EMS) and hospital Emergency Departments (ED). ⋯ Participants felt naloxone kits were an important resource and they wanted increased provision across a range of services including EMS and hospital ED staff as well as community pharmacies and needle exchange centers. Participants wanted naloxone kit provision to be extended to peers, family and friends.