Articles: emergency-services.
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A phenomenon of great concern in several Western countries is the number of patients with non-urgent ailments attending the often overloaded hospital emergency departments (EDs). With a view to providing these patients with more appropriate care, they were, in a trial at Huddinge Hospital, Sweden, advised and directed to other care facilities by a specially trained nurse. A survey indicated that 84% of the patients who agreed to a referral followed the advice given. ⋯ Moreover, the former were more likely to have a positive general attitude towards the ED. There was a positive relationship between improvement of presenting symptom and satisfaction with care at the ED, and between satisfaction and favourable attitude towards the ED. However, although patients were willing to engage in a primary health care oriented behaviour, they did not report improvement to the same extent as did ED treated patients and their general attitude towards primary health care facilities was not more favourable, at least not within a few weeks after referral.
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High patient volumes requiring rapid turn around times, critical decision making processes, and a necessity for establishing an accurate working diagnosis are a few of the many challenges in hospital emergency departments. Quality management, rather than quality assurance, most accurately describes how activities in the emergency department should be monitored to meet these challenges. Already an important factor in manufacturing and service industries across the United States, quality management will become the essential driving force in the health care industry. To survive in the '90s, the emergency department must include in its goals the development of plans and processes that meet the challenge of the ED environment and that focus on customer satisfaction.
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Comparative Study
Radiograph ordering: agreement between the triage nurse and the physician in a pediatric emergency department.
We hypothesized that the triage nurse in a busy pediatric emergency department (ED) could accurately order radiographs, ultimately reducing patient waiting time. Protocols utilized to reduce patient waiting time are of importance in busy emergency departments. All patients registering at the ED of the Children's Hospital in a one-week period were entered into the study. ⋯ The radiographs that were actually ordered by the physicians were subsequently obtained from radiology records. Data were analyzed for agreement beyond chance (kappa), positive (PPV) and negative predictive values. The results showed excellent agreement for extremity radiographs and poor agreement for nonextremity radiographs.
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All trauma admissions to the Royal Victoria Hospital, Belfast, in 1987 were entered in a computerized trauma register. Analysis of these patients by severity showed that only 3.8 per cent had ISS scores of 16 and over. Of these, 42 per cent arrived at hospital between midnight and 0900. ⋯ The specialties involved in the treatment of these patients are analysed. It is argued that we cannot instantly leap from the present arrangements to fully developed trauma centres. The most efficient and cost-effective way of initiating better systems would be to appoint sufficient accident and emergency consultants to a number of pilot scheme hospitals so that there would always be a senior doctor present, day or night, in the accident and emergency department to carry out the initial resuscitation and to mobilize the correct trauma team for the severely injured patients.
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Overcrowding of emergency departments in New York City is the most apparent symptom of a crumbling health care system. There is a growing need for the care of a largely impoverished population suffering from an increasing prevalence of AIDS, substance abuse, and psychiatric disease. ⋯ Short-term efforts to resolve this crisis have thus far been unsuccessful. Long-range solutions are likely to be costly and may require a reconfiguration of societal health care priorities.