Articles: emergency-services.
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Health Serv Manage Res · Feb 1994
Comparative StudyDo formal controls always achieve control? The case of triage in accident and emergency departments.
Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account.
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Editorial Comment
The emergency department and triage of nonurgent patients.
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The hypothesis that the use of an observation unit (OU) in the emergency department (ED) results in monetary savings by lowering the hospital admission rate for asthma was studied in a retrospective comparative cohort at an urban university county hospital. All acute asthmatic patients seen in the ED during a 22-month period were included. Preobservation patients were seen before the OU opened (n = 834); postobservation patients were treated afterward (n = 390). ⋯ However, 5.3% less patients were admitted directly to the hospital (P = .01), and 6.7% less patients were discharged directly from the ED (P = .005). The OU produced no demonstrable cost savings. The use of an OU for asthmatic patients results in lower initial discharge rates from the ED and does not reduce eventual hospital admission appreciably.
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To determine whether the use of an urban pediatric emergency department (ED) to immunize pre-school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life. ⋯ Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.