Articles: emergency-services.
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Qual Assur Health Care · Jan 1991
ReviewHigh consumers of health care in emergency units: how to improve their quality of care.
Patients with non-urgent complaints and/or who attend frequently account for a substantial portion of the visits to emergency units. These patients usually require other types of care than that provided by a highly specialized emergency department (ED). ⋯ A long-term follow-up showed that without any intervention, frequent ED users are a high-risk group as regards morbidity and mortality, especially with respect to suicide. Prevention with comprehensive and continuous treatment programmes should therefore be planned when a tendency is noted for patients to attend the ED frequently.
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Violence in the emergency department, a not uncommon but complex phenomenon, may become more serious when patients possess weapons. Searches are used frequently to reduce this danger, though guidelines for searches are not well delineated. We examined our practices in order to formalize our guidelines. ⋯ Although various factors contributed to a clear bias toward searching psychiatric patients, we believe that the rate of weapons possession did not support this bias.
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Qual Assur Util Rev · Jan 1991
GuidelineThe rational ordering of blood cultures in the emergency department.
A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and patients. ⋯ Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and admission to the hospital. This study reviews the manner in which blood cultures were ordered before and after the introduction of general guidelines for their use. It outlines a process whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other laboratory and diagnostic studies.
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Primary health care in the accident and emergency department has been a philosophy of care that reacts to more than a client's presenting complaint (reactive care). It aims not only to manage the presenting complaint, but also to integrate continuing care with disease prevention and health promotion. Primary health care in the AED is intended to build fences around the cliffs forming our healthcare problems. At the same time it also encourages the provision of intensive care ambulances for those clients unfortunate to fall before the fences are finished or who fall over the fences.
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We evaluated the Revised Trauma Score (RTS) for the rapid identification of severely injured patients on their arrival at the accident and emergency department. A total of 1407 consecutively injured patients admitted to the Accident and Emergency Department of the Royal Victoria Hospital, Belfast, had their RTSs calculated on arrival. A trauma team, consisting of experienced senior doctors, was summoned for all patients with an abnormal RTS of 11 or less. ⋯ Second, systolic hypotension following trauma is an important sign of serious injury. We recommend the use of the RTS as an aid to junior doctors in the recognition of seriously injured patients in the accident and emergency department. Furthermore, the score should be recalculated at frequent intervals while the patient remains in the department.