Articles: emergency-services.
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Comparative Study
Management of minor head injuries in the accident and emergency department: the effect of an observation ward.
The management of 483 patients presenting with minor head injury to the accident and emergency (A&E) departments of two Scottish hospitals was studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currently accepted criteria for recommending admission to hospital and 49 (17.7%) patients were actually admitted. ⋯ However, significantly fewer, 10 (4.9%) patients, were actually admitted. The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds is a major determinant of management in patients presenting with minor head injury to the A&E department and may be more influential than clinical findings.
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Feelings engendered during 585 triage nursing assessments made by a total of 10 nurses were studied. Marked differences in nurses' feelings were demonstrated towards patients attending the accident and emergency (A&E) department with 'primary care' needs compared with those assessed as having 'A&E' needs. In particular, nurses demonstrated more negative feelings, in the form of less sympathy, more irritation and less motivation to help, towards patients with 'primary care' needs. ⋯ This work is part of a larger study into developing the primary care role of accident and emergency nurses. The culture of the A&E department is discussed, and the need to challenge and change this culture to ensure it becomes more responsive to individual patients' needs is advocated. This paper calls for development of triage training and education and further investigation into the effects of nurses' attitudes on patient assessment.
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Multicenter Study Comparative Study
Review of the composition and use of trauma teams within the Trent Region.
The aim of the study was to find the existence, composition and working policies of trauma teams within the Trent Region. Data were obtained by postal survey. Despite many reports indicating a need for a unified multidisciplinary approach to trauma management, this study found that this approach was absent in many hospitals.
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Ann R Coll Surg Engl · Sep 1994
Reduction in junior doctors' hours in an otolaryngology unit: effects on the 'out of hours' working patterns of all grades.
This study aimed to assess the effects of recent controls on juniors' duty hours (the 'New Deal') on the work performed by all grades of ENT medical staff 'out of hours'. For 100 days in 1993 the out of hours duties of all grades of doctor in the Otolaryngology Unit were monitored using daily logs. Three patterns of cover were run in parallel and subjected to comparison: Light: Senior House Officer (SHO)--Consultant (CON); Traditional: SHO-Intermediate (Registrar or Senior Registrar)--Consultant; Cross-cover--Pre-Registration House Officer (PRHO)--Intermediate-Consultant. ⋯ Reduction in on-call hours of junior staff resulted in a need for cross-cover and also in the frequent removal of an intermediate tier of staff. This has been shown to have a considerable effect on working patterns for intermediate and senior grades in an ENT unit of average size. Further reductions would be expected to have major effects on the working patterns of the consultant grade and considerably dilute the emergency experience of trainees.