Articles: emergency-services.
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J Public Health Med · Jun 1992
A study of 'inappropriate' attendances to a paediatric Accident and Emergency Department.
'Inappropriate' attendance to Accident and Emergency Departments (AEDs) has been shown in many studies to be a sizeable problem. However, only one previous study has investigated inappropriate attendance to these departments amongst children. In this paper we report an investigation of 'inappropriate' usage of a children's AED in Nottingham. ⋯ This proportion was highest amongst younger children, those from families of lower social class and those living closest to the hospital. 'Inappropriate' attendance was not found to relate to the availability of general practitioners. The reasons stated for choosing to attend the AED suggested that these attendances resulted from perceptions of the adult(s) accompanying the children to the department. In view of this finding, action is required to correct these perceptions, although it is recognized that this may be difficult to achieve.
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The learning process benefits adults more when the material is presented in the presence of "positive conditions." Teaching standards developed and QA provides ample opportunity to provide positive conditions. The Marker Model is easily adapted to all practice settings and can often be taught by using unit-specific or patient population-specific examples; however, developing these specific examples can be time-consuming. ⋯ The Head of Household Standards model and the Quality Assurance Plan for Head of Household are applicable to almost all adults and are easily understood (see boxes). They supply further humor in their "audit" formats (Figures 3 and 4).
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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.
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An irregular discharge (ID) from the A&E department is an undesirable, but relatively common occurrence. A prospective study was undertaken to quantify the size of the problem and by arranging a subsequent review of the patient, to determine the clinical outcome. Over a 3-month period, 139 patients (0.73%) of attendances) took their own discharge against medical advice. ⋯ Patients with serious conditions appeared to return spontaneously for further care. Methods of minimizing the numbers of patients who take an ID or DNW are discussed. Taken together, the numbers of these attenders leaving prematurely, can be used as a valid performance indicator of the delivery of health care in the A/E department.