Articles: emergency-services.
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The results of resuscitation of the multiply-injured patient have been subjected to audit at this district teaching hospital (Lewisham) over a 6-month period in 1988. During this period the trauma team was called to 30 patients in the accident department and one death was identified as being potentially preventable. ⋯ There is now little doubt that the creation of a network of trauma centres in the United Kingdom will decrease the occurrence of preventable deaths in multiply-injured patients. However, until this network is introduced, each hospital must consider in the interim how best it can respond to the immediate needs of the multiply-injured patient.
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Physician assistants (PAs) specially trained in emergency medicine can be used effectively to work with emergency medicine physicians to provide efficient and expedient high-quality patient care. The concept of using PAs in the emergency department is reviewed, and items of concern to professionals who are reluctant to use PAs are discussed. ⋯ The PA program at Beth Israel Medical Center is used as a case study to demonstrate the use and integration of the PA within the division of emergency services. Although a well-trained emergency physician is the gold standard for quality patient care, cost-effective quality care for certain patient complaints can be rendered acceptably by others.
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J Burn Care Rehabil · Mar 1990
Practice Guideline GuidelineHospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. American Burn Association.
Each year in the United States burn injuries result in more than 500,000 hospital emergency department visits and approximately 70,000 acute inpatient admissions. Most burn injuries are relatively minor, and patients are discharged following outpatient treatment at the medical facility where they are first seen. Of those patients with injuries serious enough to require hospitalization, about 20,000 are admitted directly or by referral to hospitals with special capabilities in the treatment of burn injury. Hospitals with these service capabilities are normally termed "burn centers." This document defines the system, organizational structure, personnel, program, and physical facilities involved in establishing the eligibility of hospitals with the capability of being identified as burn centers.
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In July 1988, our emergency department adopted a policy of refusing to treat patients in the ED if they failed to have what was considered an emergency condition. Screening examinations were performed by triage nurses to determine whether patients were eligible to be seen in the ED. Patients whose vital signs fell within specific categories and who had one of 50 minor chief complaints were refused care in the ED and referred to off-site clinics. ⋯ Follow-up letters and telephone calls to their clinics identified no patients who needed retriage to an ED, and only 54 patients (1.3%) complained about their referral out of the ED. Only 42 patients returned to the ED within 48 hours of initial triage, and none had a deterioration of their condition. In conclusion, a selective triage system may be used to effectively decompress an ED, although further study is needed to identify potential rare adverse outcomes.