Articles: emergency-services.
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Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. ⋯ From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.
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Serious clinical and risk management problems arise when indigent patients with acute medical conditions are transferred from general medical hospitals or emergency departments to public psychiatric hospitals that are ill equipped to provide medical care. To combat such practices, referred to as dumping, Congress included measures in the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) prohibiting such transfers. ⋯ The key to preventing dumping is to educate referral sources to limitations on the medical care available at the receiving hospital and to discourage negligent patient transfers by enforcing COBRA. Public hospital staff and legal counsel who become familiar with COBRA's provisions can develop an antidumping strategy.
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To demonstrate the use of the computer as a tool for information storage and analysis in the emergency department (ED) with the objective of improving ED efficiency, the authors conducted a prospective study from April through September 1991. Information from charts of patients who came into the medical emergency department (MED) and surgical emergency department (SED) were checked and input into the computer. This information included triage classification, registration time, time seen, disposition, disposition time, physician's impression as well as the reasons for delayed disposition. ⋯ A commitment to providing quality care in the ED sometimes results in unreasonable waiting times for triage 3 and 4 patients, causing patient dissatisfaction. Readjustment of staffing and space use is needed. Equipping the ED with facilities to provide sonography and computed tomography would enhance patient flow; this needs further study to evaluate cost effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)