Articles: emergency-services.
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The use of emergency room time by medical and psychiatric clinicians evaluating psychiatric patients was studied. The amount of time to the completion of the medical and the psychiatric evaluation and the actual amount of time of the psychiatric evaluation were compared over demographic, admission, diagnostic, and referral factors. ⋯ The multiple time pressures in an emergency room setting appeared to affect when, but not how long, clinicians evaluated psychiatric patients. The time that emergency room clinicians take to begin evaluations of psychiatric patients may reflect important observational data that affect their temporal, diagnostic, and recommended treatment patterns.
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To determine criteria for Accident and Emergency outpatient documentation, to review current practice and to overcome identified deficiencies. ⋯ The overall standard of outpatient documentation was high. Problem areas included the recording of cause of injury, significant laboratory and radiological findings, discharge instructions and time of disposal. Forms design was criticised by some users. Overall, however, non-compliance was seen to be less of a problem than lack of awareness by staff of what is important to document in an outpatient setting.
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A system of daily patient chart review of 11 categories of physician documentation and patient care was implemented over a 36-month period at Allegheny General Hospital in Pittsburgh. A total of 108,317 charts of emergency patients were reviewed. ⋯ All physicians' charts underwent the same thorough chart review. Not only did the percentage of errors decrease from the first months to the second months of the residents' rotations, but the yearly percentage of total errors decreased as the study progressed, from 5.47% to 3.57%.
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Int J Psychiatry Med · Jan 1988
Screening emergency room patients with atypical chest pain for depression and panic disorder.
In response to recent reports relating atypical chest pain to normal coronary arteries and to various types of psychopathology, we developed a pilot study to investigate 1) the prevalence of depression and panic disorder among patients presenting to an emergency room with atypical chest pain, and 2) what the likelihood is of an emergency room physician recognizing the psychosocial factor. Of forty-nine subjects screened, 39 percent scored positively for depressive syndrome on the Center for Epidemiological Studies-Depression rating scale, 43 percent met criteria for panic attack and 16 percent met criteria for panic disorder by DSM-III. Although thirty subjects (61%) screened positively for depression or panic attack, only one received a psychiatric diagnosis of any kind. This pilot study suggests: 1) that the relationship between chest pain and psychopathology in emergency room patients deserves further rigorous study; 2) that depression and panic attacks in association with atypical chest pain may be underdiagnosed by the emergency room physician; and 3) that self-report screening measures as an aid to diagnosis in this population need to be more closely investigated.