Articles: emergency-services.
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Social science & medicine · Oct 1992
Comparative StudyPrimary care in accident and emergency and general practice: a comparison.
This paper reviews the way in which literature describing 'inappropriate' attenders at Accident and Emergency (A & E) departments in Britain has suggested that they could be provided for in General Practice and that their attendance at A & E departments therefore implies a 'failure' of general practice in urban areas. One problem with much previous research is that 'inappropriate' attenders have been retrospectively identified. ⋯ Patients attending the hospital A & E department were similar to the GP attenders in terms of socio-economic indicators, but had problems which were not typical of the general practice workload and were in different circumstances. The results suggest that there will be a continuing demand for hospital-provided primary care in urban areas, and that attempts to deflect such care to the community will meet with limited success.
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Use of emergency outpatient services is described for a 34-bed rural hospital in Alberta. One in 10 outpatients was classified as having serious and extreme emergencies. Less than 3% were transferred to a higher level of care; 10% were admitted to the local hospital. Recommendations are made for staffing, training, inventory, and funding of small rural hospital emergency departments.
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Street gang members are frequently injured, and the violence of their subculture may follow them from the streets into the emergency department. We present four cases in which in-hospital gang violence occurred or was prevented. To decrease the risk of injury from gang-related violence within the hospital, we offer guidelines for patient care and health care provider safety. Emphasis is on education, awareness, and early hospital security involvement.
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Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care. ⋯ It unifies the recording of vital signs, whilst acting as an assessment and resuscitation template. By ensuring no life-threatening illness is missed it is likely to improve patient survival. The document can act as a basis for teaching and a medico-legal record, whilst providing the necessary data for quality assurance and outcome audit.
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Pediatric emergency care · Oct 1992
Follow-up of patients with occult bacteremia in pediatric emergency departments.
Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. ⋯ Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)