Articles: emergency-services.
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Psychiatric disorders are best managed by interdisciplinary teams of psychiatrists, psychiatric nurses, social workers, and psychologists. Some Emergency Departments have access to such psychiatric services either in the hospital or in associated clinics or community mental health centers. Unfortunately, many are not staffed with mental health professionals or such expertise is available only on a limited basis, particularly on evenings and weekends. ⋯ We have reviewed the format for conducting a psychiatric history and mental status examination and have discussed the most common emergency psychiatric disorders of the elderly and their management in the Emergency Department. In order to assess and treat elderly psychiatric patients properly, emergency personnel must be aware of the medical disorders associated with psychiatric illness and must be prepared to initiate treatment quickly and appropriately. For most patients, emergency intervention is the first step in ensuring that a correct diagnosis is made and that ongoing psychiatric treatment is arranged through timely consultation and referral.
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Estimates of emergency physician needs traditionally have relied on calculations based on the number of patients seen by the emergency physician (volume formula). We have found this model has not predicted accurately manpower needs in our emergency department as the case mix of services has changed. ⋯ The LIVES formula performed better than the volume formula: a better fit with number of physicians used by chi 2 analysis (chi 2 = 1084 versus 5591), a better correlation with physicians used (regression coefficient 0.98 v 0.21), a higher degree of association with physicians used (correlation coefficient 0.96 versus 0.53 with P less than 0.0001 v 0.06 by Student's t-test), and explained more of the variability in the amount of physicians used (92% v 28%). Changes in types of services provided by the modern emergency department require multifactorial analysis to determine manpower needs.
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An examination of the social concerns of the elderly reinforces the importance of a thorough social assessment and the availability of skilled staff in an Emergency Department to make appropriate community referrals. The resolution of disposition problems brought about through caregiver exhaustion, patients no longer able to care for themselves in the community, and abandonment by individuals and institutions require a complex array of skills. The serious problem of drug and alcohol abuse among the elderly must be recognized by Emergency Department staff. ⋯ Communities with a geriatric treatment center provide a valuable resource for patients identified through Emergency Department visits. The Emergency Department must play an active role in assisting hospitals, area agencies on aging, and other concerned members of the community plan programs for elderly patients with physical and social concerns. While these changes are implemented, the Emergency Department will continue to remain responsive to the social concerns of the elderly through deliberate organizational efforts designed to maintain a high quality of care for elderly patients.
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To assess current standards of care in pediatric emergency medicine, a questionnaire was mailed in May 1988 to the medical directors of all existing pediatric emergency medicine fellowship programs. Twenty-three programs (96%) completed this survey, which consisted of questions regarding census, staffing patterns, ancillary services, patient follow-up, and various clinical issues. The major deficiencies in pediatric emergency care identified by this survey concerned patient waiting time, weekend radiology coverage, patient follow-up, feedback to referring physicians, and feedback to emergency department housestaff on hospitalized patients. The data suggest that pediatric EDs associated with fellowship training programs are improving their quality of care, yet room for advancement in many categories remains.