Articles: emergency-services.
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Work was carried out to determine whether patients requiring emergency medical or surgical admission to hospital via accident and emergency (A&E) departments benefit from initial assessment by the ward senior house officer (SHO) as well as the A&E SHO. Two comparable consultant-led A&E departments sharing the same catchment population and receiving similar numbers of new patients each year were studied. A panel of four consultants audited the A&E notes and in-patient records of consecutive emergency medical and surgical patients admitted to two hospitals over the same 6 month period. ⋯ Diagnostic errors, inappropriate admissions to hospital and admission of patients to inappropriate wards were used as outcome measures. There was no significant difference in the rates of diagnostic error or inappropriate admissions between those patients seen by an A&E SHO only, and those seen in A&E by the A&E and ward SHOs. Detaining emergency medical and surgical patients in the A&E department for further assessment by ward SHOs does not alter inappropriate admission rate or improve diagnostic accuracy.
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Pediatric emergency care · Dec 1995
Comparative StudyCharacteristics of frequent pediatric emergency department users.
The purpose of this study was to examine the medical and demographic characteristics of patients who frequently seek emergency care at a pediatric emergency department (ED). Registration information of ED visits during the study period from 11/1/87 to 5/31/92 (4.6 years) was stored in a data base. Patients with 10 or more ED visits during this study period were considered to be "frequent" ED users. ⋯ We conclude that cultural differences appeared to be an important factor associated with frequent ED use by healthy persons. Medical care resources as measured by immunizations, insurance, and identification of a primary care physician did not appear to be deficient in this cohort of frequent ED users. Since recurrent wheezing is a dominant chronic condition among frequent ED users, pediatric emergency medicine training programs may consider the inclusion of the chronic management of wheezing in their curriculum.
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Pediatric emergency care · Dec 1995
Emergency department presentation and management of pediatric heart transplant recipients.
The object of this study was to review and delineate the presenting complaints, signs, symptoms, and Emergency Department (ED) management of pediatric heart transplant recipients who presented to Loma Linda University Medical Center's (LLUMC) Emergency Department. A retrospective chart review was made of all of the pediatric heart transplant patients who presented to the ED at LLUMC from January 1986 through February 1993. The department is part of a 600-bed university hospital with an associated 250-bed children's hospital that includes a pediatric heart transplant center and an ED that sees over 38,000 patients per year. ⋯ Life-threatening conditions such as graft rejection are less likely. Nevertheless, the emergency physician should maintain caution in the evaluation of these patients. Close cooperation and consultation with the transplant team will assure the optimal outcome for these patients.
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For the majority of studies on hospital readmission rates, a readmission is deemed to have occurred if a patient was admitted within 28 days of the previous discharge date. This time period, however, has rarely been justified clinically or statistically and certainly not in Australia. In examining the patterns of readmissions to NSW public acute hospitals, this study provides statistical support for the use of a 28 day interval for total readmissions. The same finding applies to the four admission categories of medical, surgical, paediatrics, and obstetrics and gynaecology.