Articles: emergency-services.
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Multicenter Study Clinical Trial
Physician electrocardiogram reading in the emergency department--accuracy and effect on triage decisions: findings from a multicenter study.
To determine how well physicians in emergency departments read electrocardiographic (ECG) ST-segment and T-wave changes and how this affects triage decisions. ⋯ Physicians in emergency departments often misread the ST segments and T waves of patients with possible acute cardiac ischemia. Misreading is related to suboptimal triage and unnecessary CCU admission. Training emergency physicians to make these distinctions more accurately could improve medical care and hospital utilization.
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Multicenter Study Comparative Study Clinical Trial
Use of emergency departments by elderly patients: projections from a multicenter data base.
To assess the use of emergency medical care by the elderly in the United States, including emergency department visits, level of ED care required, ambulance services, and hospital admission rate. ⋯ With the rapid growth of the size of the elderly population, it is important that we assess the emergency medical resources needed to care for the geriatric population.
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Multicenter Study Comparative Study Clinical Trial
Geriatric patient emergency visits. Part II: Perceptions of visits by geriatric and younger patients.
To compare group perceptions of reasons for emergency department care, ED use patterns, and the effect of illness on self-care ability for elderly and younger adult patients. ⋯ The elderly use the ED for reasons similar to those for younger adults. Often they feel too ill to wait for an office visit or are referred in by their primary care provider. Elderly patients more commonly have difficulty with self care after release home, and emergency physicians must plan accordingly.
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Comparative Study
Peer review organization payment denials: comparative analysis of emergency department and non-emergency-department admissions.
The Health Care Financing Administration has contracted with regional peer review organizations to review Medicare admissions and to deny payment for hospital admissions that fail to meet peer review organization criteria. The purpose of this study was to compare emergency department admissions with non-emergency-department admissions with respect to rates of peer review organization denial and the reasons for those denials. All hospital Medicare admissions between January 1984 and April 1987 were retrospectively reviewed. ⋯ Of the 11,865 non-emergency department, non-pre-authorized admissions, 333 (2.81%) were denied. Of these denials, 174 (52.2%) were appealed, 76 (43.6%) successfully. Overall, emergency department admissions were significantly less likely to receive peer review organization denial than non-emergency-department, non-pre-authorized admissions (P less than 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)
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A retrospective chart review was performed on 52 consecutive discharges against medical advice (AMA) from an emergency department. The study's objective was to assess documentation of the medical record as well as the patients' perceptions of their experience. Sixty-seven percent of the charts reflected the competence of the patient. ⋯ The discharge instructions included a referral to a physician 62% of the time. A post-visit survey contacting 46% of the group revealed that 82% of these respondents left because they didn't agree with the physician's management plan, although 70% of the patients were either "very satisfied" or "satisfied" with their interaction with the physician. These results suggest that more attention and better documentation needs to be directed to the patient who is leaving the emergency department against medical advice.