Articles: emergency-department.
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Randomized Controlled Trial
Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study.
The Affordable Care Act initiated several care coordination programs tailored to reduce emergency department (ED) use for Medicaid-enrolled frequent ED users. It is important to clarify from the patient's perspective why Medicaid enrollees who want to receive care coordination services to improve primary care utilization frequently use the ED. ⋯ Medicaid frequent ED users engaged in receiving patient navigation services with the goal to reduce ED use and hospital admissions describe barriers that go beyond timely primary care access issues. These include sociodeterminants of health, lack of trust in primary care providers, and healthcare system.
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Randomized Controlled Trial Multicenter Study Comparative Study
Coronary Computed Tomography Angiography Versus Traditional Care: Comparison of One-Year Outcomes and Resource Use.
Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial. ⋯ A coronary CT angiography-based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1% major adverse cardiac event rate during the first year after testing.
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Randomized Controlled Trial
Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers.
Although ultrasound-guided regional nerve blocks have become more commonplace in the emergency department, there is no evidence to suggest that they are more effective than traditional landmark-based wrist blocks for hand anesthesia. We hypothesized that ultrasound-guided forearm nerve blocks would provide superior analgesia as compared with conventional landmark-based wrist blocks. ⋯ Ultrasound-guided forearm nerve blocks performed by an experienced operator result in more effective hand anesthesia than traditional anatomic landmark-based wrist blocks.
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Randomized Controlled Trial
Alignment of site versus adjudication committee-based diagnosis with patient outcomes: Insights from the Providing Rapid Out of Hospital Acute Cardiovascular Treatment 3 trial.
Adjudication by an adjudication committee in clinical trials plays an important role in the assessment of outcomes. Controversy exists regarding the utility of adjudication committee versus site-based assessments and their relationship to subsequent clinical events. ⋯ Despite substantial agreement between the diagnosis of emergency department physicians and adjudication committee, in the subgroup of patients where there was disagreement, there was significantly worse short-term and long-term mortality.
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Randomized Controlled Trial
BRIPPED scan for evaluation of ED patients with shortness of breath.
The BRIPPED scan is an ultrasound evaluation of pulmonary B-lines, right ventricle size, inferior vena cava collapsibility, pleural and pericardial effusion, pneumothorax, left ventricle ejection fraction, and lower extremity deep venous thrombosis. The primary goal was to evaluate the effect of the BRIPPED scan on the physician's list of differential diagnoses for patients presenting with shortness of breath. ⋯ The BRIPPED scan is a rapid ultrasound evaluation of shortness of breath in the emergency department. BRIPPED influenced physician differential diagnoses to the same degree as laboratory and radiographic testing. BRIPPED did not alter the final diagnosis in this patient population.