Articles: emergency-services.
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Observational Study
Inequities among patient placement in emergency department hallway treatment spaces.
Limited capacity in the emergency department (ED) secondary to boarding and crowding has resulted in patients receiving care in hallways to provide access to timely evaluation and treatment. However, there are concerns raised by physicians and patients regarding a decrease in patient centered care and quality resulting from hallway care. We sought to explore social risk factors associated with hallway placement and operational outcomes. ⋯ While hallway usage is ad hoc, we find consistent differences in care delivery with those insured by Medicaid and self-pay or male sex being placed in hallway beds. Further work should examine how new front-end processes such as provider in triage or split flow may be associated with inequities in patient access to emergency and hospital care.
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Falls that occur within a hospital setting are difficult to predict, however, are preventable adverse events with the potential to negatively impact patient care. Falls have the potential to cause serious or fatal injuries and may increase patient morbidity. Many hospitals utilize fall "predictor tools" to categorize a patient's fall risk, however, these tools are primarily studied within in-patient units. The emergency department (ED) presents a unique environment with a distinct patient population and demographic. The Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT) has shown to be effective with predicting a patient's fall risk in the ED. This IRB-approved study aims to assess the predictive validity of the MEDFRAT by evaluating the sensitivity and specificity for predicting a patient's fall risk in an emergency department at a level 1 trauma center. ⋯ This study confirms the validity of the MEDFRAT as an acceptable tool to predict in-hospital falls in a level 1 trauma center ED. Accurate identification of patients at a high risk of falling is critical for decreasing healthcare costs and improving health outcomes and patient safety.
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Observational Study
Impact of emergency department length of stay on in-hospital mortality: a retrospective cohort study.
Emergency Department (ED) workload may lead to ED crowding and increased ED length of stay (LOS). ED crowding has been shown to be associated with adverse events and increasing mortality. We hypothesised that ED-LOS is associated with mortality. ⋯ In this retrospective cohort study, there was no independent association between ED-LOS before admission to general non-ICU wards and in-patient mortality.
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Ocular emergencies comprise 2-3% of emergency department (ED) visits, with retinal detachment requiring emergency surgery. Two-dimensional ultrasound is a rapid bedside tool but is highly operator dependent. ⋯ A 3DUS-enabling device demonstrates a sensitivity of 0.81 and specificity of 0.73 for disease detection, fast image acquisition, and may reduce operator dependence for detecting emergent retinal pathologies. Further technological development is needed to improve diagnostic accuracy in identifying and characterizing retinal pathology.
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Most cases of pediatric epistaxis are spontaneous and self-resolve. However, a subset of children may experience significant bleeding and require procedural or medical intervention. ⋯ Epistaxis severity is associated with certain risk factors. However, most cases of pediatric epistaxis are mild and do not require intervention or ED evaluation.