Articles: emergency-services.
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Dtsch. Med. Wochenschr. · Aug 2024
Review[Monitoring of cardiovascular emergencies in the emergency department].
In the emergency department, patients with potential or confirmed cardiovascular diseases constitute a significant portion of the overall patient population. Monitoring for cardiovascular surveillance of these patients, until and during the diagnostics and acute therapy often presents an interdisciplinary and interprofessional challenge. This is partly due to the limited number of monitoring spaces in emergency departments. ⋯ The provision of an intensive care bed for further care within one hour is aimed for according to the directive of the Federal Joint Committee on staged emergency care in hospitals. Often, at the beginning of the emergency department visit, a definitive diagnosis is not yet established - this is addressed accordingly with symptom-oriented considerations. The present review article focuses on the practical Implementation and modalities of monitoring, as well as its application in a selection of cardiovascular diagnoses in the emergency department.
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Emergency department (ED) boarding of psychiatric patients is a national issue that continues to worsen at a disturbing rate. Implementing strategies in the ED to provide continuous care for patients can help secure patient safety. ⋯ Patients with psychiatric disorders boarding in the ED need careful consideration of management plans to mitigate patient safety events.
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The changing hospital business model has raised ethical issues for emergency physicians (EPs) in a healthcare system that often prioritizes profits over patient welfare. For-profit hospitals, driven by profit motives, may prioritize treating patients with lucrative insurance plans and those who can afford expensive treatments. Private equity investors, who now own many for-profit hospitals, focus on short-term financial gains, leading to cost-cutting measures and pressure on EPs to prioritize financial goals over patient welfare. Nonprofit hospitals, mandated to provide charity care to the underserved, may fail to meet their community service obligations, resulting in disparities in healthcare access. ⋯ Emergency physicians must navigate these ethical issues while upholding professional ethics and advocating for patients' best interests. Collaboration with hospital administrators, policymakers, and stakeholders is vital to address these concerns and prioritize patient welfare in healthcare delivery.
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The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. ⋯ The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Critical care clinics · Jul 2024
ReviewCritical Care Delivery in the Emergency Department: Bringing the Intensive Care Unit to the Patient.
Boarding of critically ill patients in the Emergency Department (ED) has increased over the past 20 years, leading hospital systems to explore ED-focused models of critical care delivery. ED-critical care delivery models vary between health systems due to differences in hospital resources and the needs of the critically ill patients boarding in the ED. Three published systems include an ED critical care intensivist consultation model, a hybrid model, and an ED-intensive care unit model. Paraphrasing the Greek philosopher, Plato, "necessity is the mother of invention." This proverb rings true as EDs are facing an increasing challenge of caring for boarding patients, especially those who are critically ill.