Articles: emergency-services.
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Jt Comm J Qual Patient Saf · Jan 2009
Multicenter StudyBarriers to emergency departments' adherence to four medication safety-related Joint Commission National Patient Safety Goals.
Medication errors are a serious public health threat, causing patient injury and death and sharply increasing health care costs. Serious preventable errors are most likely to occur in areas of increased complexity and technology, such as the emergency department (ED). Although The Joint Commission in 2002 approved the first set of National Patient Safety Goals (NPSGs) to decrease the occurrence of health care errors, the literature suggests that the goals are not fully implemented. In 2006, the Emergency Nurses Association (ENA) conducted a national, multisite survey (1) to describe barriers to full implementation of the 2006 NPSGs related to medication safety (then known as Goals 1, 2, 3, and 8) as reported by ED registered nurses (ED nurses) and (2) to investigate factors related to those barriers. ⋯ The low response rate (4.6%) to this study inherently limits the overall generalizability of the findings to the greater population of EDs. Yet, the findings suggest that substantial barriers remain to ED adherence to the NPSGs related to medication safety. Efforts to reduce the barriers should focus on system changes that facilitate adherence. Health care providers and their organizations must commit to and enforce a zero-tolerance policy for preventable medication errors.
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Multicenter Study
Influence of season and temperature on the relationship of elemental carbon air pollution to pediatric asthma emergency room visits.
Previous studies have demonstrated an association between air pollution and asthma exacerbation. Less understood is the effect of elemental carbon (EC), and the interaction of EC with temperature, on increases in pediatric asthma emergency department visits and how these relationships change across the seasons in a metropolitan area with several industries and relatively low air pollution. Measurements of EC, ozone (O(3)), sulfur dioxide (SO(2)), and total oxides of nitrogen (NO(x)) were available from the St. ⋯ During the winter, a 0.10 microg/m(3) increase in EC resulted in 2.80% increase in asthma ED visits among 11-17-year-olds (95%CI = 1.01,1.05) at the median seasonal temperature (43.3 degrees F). This risk increased with decreasing temperature. Among 11-17-year-olds, daily number of asthma ED visits is associated with increased levels of EC at higher temperatures in the summer and lower temperatures in the winter.
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Federal policy changes and tightened state budgets may reduce Medicaid enrollment in many states. In March 2003, the Oregon Health Plan (Oregon's Medicaid expansion program) made substantial changes in its benefit package that resulted in the disenrollment of more than 50,000 beneficiaries. We sought to study the impact of these Oregon Health Plan policy changes on statewide emergency department (ED) use. ⋯ Oregon's Medicaid cutbacks were followed by increases in ED use and hospitalizations by the uninsured. Recent federal legislation facilitating similar Medicaid changes in other states may lead to replication of these events elsewhere.
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Multicenter Study
Frequent attenders at emergency departments: a linked-data population study of adult patients.
To examine the characteristics of adult patient attendances to emergency departments (EDs) in Perth hospitals by patients' frequency of attendance. ⋯ Most FAs at Perth EDs present fewer than 20 times a year and have more serious and urgent illness than other patients, more often requiring inpatient services. A very small minority of patients (around 100 patients/year) attends 20 or more times a year, many with mental and behavioural disorders and alcohol intoxication not requiring hospital admission.