Articles: emergency-services.
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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.
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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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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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Randomized Controlled Trial Clinical Trial
Standardized instructions: do they improve communication of discharge information from the emergency department?
To determine whether standardized instructions enhance communication of discharge information, we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department: (1) instruction by individual housestaff and medical students after consultation with an attending physician (control group); (2) standardized verbal instructions given by housestaff and students trained in their use (verbal group); or (3) the same instructions given to the verbal group, together with a type-written copy of the information to take home (verbal + written group). Prior to leaving the emergency department and, again, by phone, 1 and 3 days later, parents were questioned concerning the prescribed medication's name, dose, frequency, and duration of administration (medication data), three signs of improvement, and eight signs indicating the need for medical advice (worrisome signs). ⋯ Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs. The addition of written instructions to standardized verbal instructions did not improve parental recall of discharge information.