Articles: emergency-services.
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Multicenter Study Observational Study
Modelling attending physician productivity in the emergency department: a multicentre study.
Emergency physician productivity, often defined as new patients evaluated per hour, is essential to planning clinical operations. Prior research in this area considered this a static quantity; however, our group's study of resident physicians demonstrated significant decreases in hourly productivity throughout shifts. We now examine attending physicians' productivity to determine if it is also dynamic. ⋯ Physician productivity over a single shift follows a predictable pattern that decreases significantly on an hourly basis, even if there are new patients to be seen. Estimating productivity as a simple average substantially underestimates physicians' capacity early in a shift and overestimates it later. This pattern of productivity should be factored into hospitals' staffing plans, with shifts aligned to start with the greatest volumes of patient arrivals.
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Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases. ⋯ Only half of patients discharged from an ED with a new diagnosis of atrial fibrillation, heart failure, and hypertension were seen within a week of being discharged. Patients with significant comorbidities were less likely to obtain follow-up care, as were those with a family physician who was remunerated via primarily capitation methods.
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Multicenter Study
Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment.
We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites. ⋯ In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools.
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Multicenter Study Comparative Study
Comparative Effectiveness of Initial Treatment at Trauma Center vs Neurosurgery-Capable Non-Trauma Center for Severe, Isolated Head Injury.
Head injury is an increasing contributor to death and disability, particularly among the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers would have lower rates of mortality and higher rates of discharge home without services than those treated at non-trauma centers. ⋯ Patients with isolated, severe head injury have better outcomes if initially treated in designated trauma centers. As 40% of such patients were triaged to non-trauma centers, there are major opportunities for improving outcomes.
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Multicenter Study
Measurement Under the Microscope: High Variability and Limited Construct Validity in Emergency Department Patient-Experience Scores.
We evaluate variability and construct validity in commercially generated patient-experience survey data in a large sample of US emergency departments (EDs). ⋯ In this sample, both physician- and facility-level patient-experience data varied greatly month to month, with physician variability being considerably higher. Facility-level scores have greater construct validity than physician-level ones. Optimizing data gathering may reduce variability in ED patient-experience data and better inform decisionmaking, quality measurement, and pay for performance.