Articles: emergency-services.
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Comparative Study
Quality assurance in the emergency department: evaluation of the ECG review process.
To determine whether the review of emergency department ECGs by cardiologists contributes to the quality of patient care. ⋯ Review of ED ECGs by cardiologists did not affect patient care at our institution.
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To evaluate factors influencing emergency physician staffing patterns in an important subset of US hospitals. ⋯ Responding institutions included 160 private and 115 public hospitals, 74 of which were Veterans Administration hospitals. Formal medical school affiliation was noted by 86% of responding institutions, and 82 (30%) supported emergency medicine residency programs. Full-time attending emergency physician staffing varied widely, from less than one to more than three FTEs per 10,000 visits; however, mean levels of staffing at public hospitals did not differ significantly from private institutions (2.7 +/- 1.6 vs 2.5 +/- 3.1, respectively; P = .50). Three of four hospitals reported using part-time emergency physician attending but only 33% used nurse practitioners or physicians' assistants. Two thirds of responding hospitals used rotating house officers-in-training. Of note, hospitals that supported emergency medicine residency programs reported significantly higher levels of staffing by housestaff (2.2 +/- 1.8 vs 1.0 +/- 1.2 FTEs/10,000 visits; P less than .0004), but levels of total staffing by full- and part-time attending physicians were virtually identical (2.69 +/- 1.6 vs 2.67 +/- 2.6 FTEs/10,000 visits; respectively; P = .95). Marked variability in levels and patterns of ED staffing at public and teaching hospitals currently exists, but the differences are not explained by hospital ownership. The reasons for such variations and their implications for patient care must be explored.
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This paper reports the results of a retrospective review which analysed emergency admissions and readmissions of elderly patients to a district general hospital. All patients received standard after-care allocated by the community health and social services departments following referral by hospital staff. ⋯ The findings show that the patients randomly allocated to receive the modest domiciliary after-care service were less likely to have another emergency readmission or multiple readmissions. The results suggest that patients over 75 years-of-age, living alone, or having two or more emergency admissions within six months, should have a domiciliary assessment and follow-up after hospital discharge.
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To determine the frequency of, and patient population requiring involuntary treatment orders in the emergency department. ⋯ The frequent need for involuntary treatment orders for patients in an urban ED is reported. The patient population described, especially among restrained patients, differs significantly from those of studies performed in psychiatric settings. Legal doctrines pertinent to involuntary treatment are reviewed.
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To compare a new 22-lead ECG with the 12-lead ECG for diagnosis of acute myocardial infarction (AMI). ⋯ When combined with clinical judgment, the 22-lead ECG could provide a 97.6% sensitivity for AMI diagnosis while reducing unnecessary admissions for "rule-out MI" by 69%.