Articles: emergency-services.
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In a prospective study lasting 6 months, all missed injuries in patients visiting the casualty department or admitted to the orthopaedic department of Aarhus Amtssygehus were registered and analysed. A total of 15,806 patients attended the casualty department and 783 patients were admitted to the orthopaedic department. ⋯ Twenty-three injuries were missed in 17 patients in the orthopaedic department making a missed injury rate of 2.2 per cent. Re-examination of all patients and matching radiographs reduced the number of missed injuries significantly.
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We evaluated the frequency with which blood alcohol concentrations were obtained in emergency department patients with presumed alcohol impairment, whether physicians counseled impaired patients not to drive, and whether safe transportation was available. ⋯ Presumed alcohol-impaired patients seen in emergency departments frequently have blood alcohol concentrations measured. Despite documented evidence of driving impairment there is little evidence that such patients are counseled not to drive or that safe transportation home is available.
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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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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.