Articles: emergency-services.
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Comparative Study
Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department.
Knowledge of the range of pediatric illness presenting to a general emergency department (ED) is needed to optimize the quality of care delivered there. It was hypothesized that the pediatric population treated at a general ED exhibited a broad range of medical complaints, while differing significantly from children seen in a pediatric ED. General ED records from 1 week each season were reviewed, and patient age, chief complaint, diagnosis, time of arrival, season, and disposition were recorded. ⋯ General ED patients were older (7.9 vs 6.0 years, P less than .001) and admitted less frequently (3.8% vs 11%, P less than .001). Admission rates varied by arrival time only at the general ED, where minor trauma was more common (41% vs 22%, P less than .001). It is concluded that a wide range of pediatric illness is treated in a general ED, supporting the decision to have pediatric emergency physicians on staff, and that significant differences exist in the spectrum and frequency of pediatric illness seen in a general ED and pediatric ED.
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The incidence and causes of drug-related hospital admissions and visits to an emergency department were evaluated. A retrospective chart review was conducted to identify drug-related visits and admissions for all patients who visited the emergency department of a 517-bed tertiary-care institution during a four-month period. Drug-related illnesses were classified as adverse drug reaction (ADR), overdose or abuse, noncompliance, drug interaction, or toxicity. ⋯ The average length of stay for patients who were admitted was 5.8 days, and the average cost of admission was $8888. Drug-related illnesses accounted for 2.9% of hospital admissions and visits for patients in the emergency department. The most commonly identified drug-related illnesses were overdose or abuse, noncompliance, and ADRs; the drug classes most commonly implicated were drugs of abuse, anticonvulsants, and antibiotics.
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An inappropriate patient transfer from the emergency room results in less-than-quality care, cost concerns, and patient and staff dissatisfaction. The emergency room physicians at a 162-bed community hospital reported that patients were being transferred needlessly from the emergency room to other acute care facilities. An investigation of the issue documented lost revenues and concerns about the quality of patient care. Based on the findings of the investigation, specific recommendations were proposed to monitor and evaluate the quality of patient care provided in the emergency room.
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To determine the incidence and causes of unexpected death in emergency department patients and its relationship to initial ED presentation. To determine if length of ED stay is directly related to unexpected death. ⋯ Unexpected ED death was uncommon, usually nontraumatic, and occurred in patients with evidence of significant illness. Although average length of stay in the ED increased, there was no increase in the incidence of unexpected ED death. If lengths of ED stay continue to increase, this situation will require further study.