Articles: emergency-services.
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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.
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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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Occult bacteremia, which precedes many serious infections in children, is most often due Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, or Salmonella species. Diagnosis on the basis of clinical judgment is unreliable, although the presence of certain risk factors may suggest the diagnosis. ⋯ Although results are delayed, a culture of blood is the only definitive test. Studies suggest that treatment with various antibiotics may be helpful, but that some drugs, particularly orally administered amoxicillin, should not be relied on to eliminate occult bacteremia or prevent its most serious sequela, meningitis.
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Negative outcome management depends upon reducing variances in the structure and process of health care. In the multitask environment of a hospital's emergency department (ED), a system is required to monitor the many tasks for variances. ⋯ Structure and process variance management requires a customer-focused, process-conceptualization approach that attempts to manage the many small variances in care along the entire chain of interdependent processes making up the ED system. Process mapping is one technique that enables management to understand and anticipate variances and take corrective action to eliminate them before they occur.