Articles: emergency-services.
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Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. ⋯ Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings.
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J Public Health Med · Jun 1994
Attendance at accident and emergency departments: unnecessary or inappropriate?
The proportion of attenders at accident and emergency (A&E) departments who present 'inappropriately' with conditions which could be managed in general practice has been estimated at between 6.7 per cent and 64-89 per cent. These estimates have been based on subjective assessments by clinicians, or on an objective classification developed by the Nuffield Provincial Hospitals Trust (NPHT). This study sought to validate this classification, and to develop and validate other objective systems of classifying A&E attenders. ⋯ This method was applied retrospectively to random samples of 8877 adult self-referrals to 16 English A&E departments, and yielded an estimate that 23 per cent could have been treated in general practice. This approach provides a simple and valid retrospective method for identifying patients who were suitable for care in general practice. The method may be used to identify groups of patients who frequently attend inappropriately, to identify areas in which primary care needs are not being effectively met in general practice, and to form a basis for planning and auditing strategies to meet those needs in a more appropriate setting.
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The objective of this study was to audit the initial management of patients with upper limb fractures, and to determine whether the accident and emergency (A&E) management of fractures is improved by using guidelines for treatment and referral. This was achieved by comparing the standard of treatment, as determined by fracture clinic doctors, before and after the introduction of fracture treatment guidelines in the A&E department of a London teaching hospital. A total of 326 patients seen in the department and referred to the fracture clinic over two 2-month periods were included in the audit. ⋯ After introducing the guidelines the total errors fell to 14/111 (12.6%) patients referred, of which only eight patients (7.2%) were at risk of increased morbidity. This represents an overall improvement of 19.5% [95% confidence interval (CI) 12.3 to 29.7%] and a 16.5% (95% CI 9.1 to 23.9%) reduction in the potentially more significant errors. Hence, the use of audit and implementation of simple guidelines for fracture management in an A&E department improves the standard of treatment.
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Comparative Study
Major incident planning in South East Thames Region: a survey of medical staff awareness and training.
In order to assess awareness and training of medical staff in major incident planning and disaster medicine, a telephone survey was conducted throughout South East Thames Region. Duty consultants and trainees in anaesthesia, general surgery and orthopaedic surgery from a total of 17 hospitals in the region were included. Accident and emergency (A&E) consultants were also interviewed in order to assess administrative aspects of major incident planning. ⋯ We conclude that major incident plans are in place and are updated in all the hospitals surveyed. However, all staff lack training in clinical and administrative aspects of major incident planning and disaster medicine. Recommendations to improve this situation are made.
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Poor initial assessment contributes to morbidity and mortality in acute severe asthma. We have audited this aspect of management in an A & E department over a single 6-month senior house officer employment cycle. The use of a cheap and simple stamp highlighting important clinical features of asthma was associated with a significant improvement in early assessment.