Articles: emergency-services.
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1) To describe the pattern of return visits to the emergency department (ED) among elders over the six months following an index visit; 2) to identify the predictors of early return (within 30 days) and frequent return (three or more return visits in six months); and 3) to evaluate a newly developed screening tool for functional decline, Identification of Seniors At Risk (ISAR), with regard to its ability to predict return visits. ⋯ In the first month after an ED visit, return rates are highest and are more likely to be for the same diagnosis. Both medical and social factors predict early and frequent returns to the ED; patients at increased risk of return can be quickly identified with a short, self-report questionnaire. The ISAR screening tool, developed to identify patients at increased risk of functional decline, can also identify patients who are more likely to return to the ED.
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Prog Cardiovasc Nurs · Jan 2000
Multicenter StudyThe emergency department experience of chest pain patients and their intention to delay care seeking for acute myocardial infarction.
This study investigated how patients' emergency department experience was related to their intention to delay action in response to future symptoms of acute myocardial infarction. A sample of 426 persons admitted to the emergency department with a chief complaint of chest pain and released from the emergency department were contacted by telephone. Patients were queried about their affective response to the emergency department experience, their satisfaction with emergency department staff communication, their intention to delay prompt action for acute myocardial infarction symptoms in the future, the influence of others in the decision to seek care, and medical and demographic status. ⋯ The results also showed that those patients who were prompted by health professionals to go to the emergency department were less likely to report intentions to delay for future symptoms (p = 0.036). It is important that emergency department staff reassure chest pain patients who are sent home that they did the right thing by coming to the emergency department for their symptoms. Providers need to be particularly sensitive to feelings of embarrassment.
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To identify provider-based differences in the ED assessment and management of children presenting with uncomplicated, first-time febrile seizures. ⋯ There were significant setting-based differences in the evaluation and management of children with simple febrile seizures presenting to GEDs and PEDs.
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Multicenter Study
General hospital services for deliberate self-poisoning: an expensive road to nowhere?
This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. ⋯ In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.
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Am. J. Respir. Crit. Care Med. · Sep 1999
Multicenter Study Comparative StudyAcute asthma among pregnant women presenting to the emergency department.
Asthma complicates up to 4% of pregnancies. Our objective was to compare emergency department (ED) visits for acute asthma among pregnant versus nonpregnant women. We performed a prospective cohort study, as part of the Multicenter Asthma Research Collaboration. ⋯ Pregnant women were equally likely to be admitted (24% versus 21%, p = 0.61) but less likely to be prescribed corticosteroids if sent home (38% versus 64%, p = 0.002). At 2-wk follow-up, pregnant women were 2.9 times more likely to report an ongoing exacerbation (95% CI, 1.2 to 6.8). Among women presenting to the ED with acute asthma, pregnant asthmatics are less likely to receive appropriate treatment with corticosteroids.