Articles: emergency-services.
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Records of 197 patients admitted to hospital with head injury were studied retrospectively to assess the influence of altered conscious state on injury misdiagnosis in the Emergency department (ED). Diagnostic errors were identified by discrepancies between an initial Injury Severity Score (ISS) calculated according to injuries diagnosed in the ED and a final ISS based on diagnoses confirmed on discharge from hospital, or death. The Glasgow Coma Scale (GCS) was used to assess neurological status. ⋯ The risk of injury misdiagnosis was greatest for thoracic, abdominal and spinal injury, followed in descending order by extremity (limb), head, and external (skin and subcutaneous) injury. Although there was no linear correlation between GCS and ISS discrepancy rate, ISS discrepancies were significantly more frequent in comatose patients that in non-comatose patients (chi 2 = 3.69, 1 df; P < 0.05). Individual staff performance is at least as important as head injury severity in determining diagnostic accuracy on initial assessment in the ED.
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To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. ⋯ The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.
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To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences. ⋯ Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.