Articles: emergency-services.
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We surveyed the 66 accredited emergency medicine residency programs in the United States during 1986 on the issue of attending coverage. Responses were received from 411 residents and 288 faculty; this accounted for 42% of the residents and 56% of the faculty from the 56 responding programs. Seventy-three percent of emergency medicine residency programs had 24-hour attending coverage. ⋯ Ninety-five percent of faculty and 71% of residents thought that the quality of patient care was better when faculty were present in the ED (P less than .0001). Sixty-one percent of residents and 60% of faculty did not think that 24-hour attending coverage in academic emergency medicine should be mandated. The impact of night-time attending coverage in emergency medicine residency programs on patient care, resident education, and faculty development is unclear and minimally studied.
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J Health Soc Policy · Jan 1989
ReviewMedical indigency and inner city hospital care: patient dumping, emergency care and public policy.
This paper discusses the growing lack of private for-profit hospital care for the medically indigent. The issues of patient dumping and emergency care are examined from both judicial and public policy perspectives. The paper concludes by noting that dumping may be viewed as a most serious form of neglect and more comprehensive laws and court decisions are needed to require all hospitals, regardless of ownership, to treat all patients who arrive at their doors if they have the appropriate medical staff and facilities.
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Combined teaching methods may improve recall and comprehension of discharge instructions. It is not clear from the study whether improved recall and comprehension resulted in better compliance. However, complications from head injuries, although rare, can be life threatening. ⋯ If additional time is available or the person does not appear to understand the instructions, reinforcement of content should be provided. It also is recommended that discharge instructions be written at a fifth-grade reading level, avoiding technical and medical terms. With research, emergency nurses can develop and evaluate effective and efficient teaching/learning strategies.
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In a trial, patients who came to a hospital Emergency Department (ED) with non-urgent complaints were advised and referred to primary health care outside the hospital. The effect of this was assessed by measuring health care utilization one year before and one year after the referral, using the Stockholm County computerized medical information system and ED medical records. The proportion of the 189 referred patients who visited the ED decreased from 48% to 42%, whereas in a control group of 107 patients the proportion increased from 41% to 51%. ⋯ These frequent ED users did not reduce their ED utilization more than frequent ED users in the control group. The use of health care centres increased in the referred group and was practically unchanged in the control group. However, those referred patients who continued to use the ED still quite often did so for non-urgent complaints.
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The Milbank quarterly · Jan 1989
Nonemergency visits to hospital emergency rooms: a comparison of blacks and whites.
Both blacks and whites go to hospital emergency rooms for nonemergency health problems. Age, marital status, and health conditions are significant sociodemographic determinants for blacks' visits on these occasions, while those for whites include sex, age, education, insurance, employment status, region of residence, and health conditions. Despite the significant differences in determinants, similar influences bear on the two groups' decision to utilize medical services generally. Discrete analyses are still needed of cultural and interracial variation affecting the use of health facilities, together with intensive assessment of community characteristics in which the facilities are located, especially among black populations.