Articles: emergency-services.
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Multicenter Study Comparative Study
Walk-in clinics in Ontario. An atmosphere of tension.
To explore family practice (FP), emergency department (ED), and walk-in clinic (WIC) physicians' perceptions and experiences regarding the effect of walk-in clinics on Ontario's health care system. ⋯ Both FP and ED participants acknowledged their contribution to the gap in primary care services. They appeared to attribute current problems in health care delivery to the perceived deficiencies of WICs. The outcome was a marked tension among participants.
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Multicenter Study
Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study.
We derive a decision rule to partition emergency department patients with suspected pulmonary embolism (PE) into a small, high-risk group (>40% pretest probability) that is unsafe for D -dimer testing and a larger group that is safe to have PE ruled out with either a whole-blood D -dimer plus alveolar deadspace measurement or a quantitative D -dimer assay. ⋯ Simple clinical criteria can permit safe D -dimer testing in the majority of ED patients with suspected PE. These criteria warrant prospective validation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A randomized, controlled trial of clinical information shared from another institution.
Emergency physicians often must deliver medical care with minimal access to historical clinical information. We demonstrate the feasibility and potential value of increased access to patients' clinical information from another hospital while they are receiving care in the emergency department. ⋯ Our pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at 1 of 2 hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.
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Multicenter Study
Evaluation of patient satisfaction and outcomes after assessment for acute ankle injuries.
Physicians argue that patient preferences influence their test ordering and their potential for compliance with clinical practice guidelines (CPG). This study was conducted to evaluate patient satisfaction with clinical practice in emergency department (ED) settings using a validated and widely publicized set of CPGs. Patients presenting to 4 hospital EDs were eligible if they had sustained acute ankle or foot injuries. ⋯ Overall, 76% of physicians supported the use of CPGs; however, 78% reported that patient expectations influenced their application of the Ottawa Ankle Rules. This study suggests that patients are equally satisfied with care, access additional health care services similarly and obtain the same percentage of radiographs irrespective of the initial ED ankle/foot radiograph ordering. These results may help physicians in re-evaluating their perceptions that patient expectation influence utilization and have important implications in guideline development.
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Multicenter Study
ED management of cellulitis: a review of five urban centers.
Cellulitis is a common problem presenting to the emergency department (ED). This study examines the epidemiology of cellulitis in 5 Canadian urban EDs and determines the practice variation in this management among sites. From computerized provincial ED diagnosis information, 10% of cellulitis charts from April 1, 1997 to March 31, 1998 were randomly selected for review. ⋯ Cellulitis is a common ED problem which consumes considerable resources to treat. Considerable practice variation exists with respect to in-ED and post-ED management. These results suggest the need for the development of practice guidelines for the treatment of this common ED problem.