Articles: emergency-services.
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Journal of gerontology · Nov 1987
Comparative StudyPatterns of use of the emergency department by elderly patients.
The spectrum of illness and use patterns of 540 elderly patients (greater than or equal to 65 years) admitted to an emergency department (ED) were compared to an equal number of nonelderly patients. The proportion of visits by the elderly group to the ED was similar to the proportion of elderly residents in the area surrounding the hospital. Elderly patients were more likely than nonelderly patients to have an emergent diagnosis (34.4 vs. 8.3%), to arrive by ambulance (54.6 vs. 23.5%), to be admitted to the hospital (51.1 vs. 14.4%), and to have a medical (as opposed to a surgical) illness (75.0 vs. 53.2%). ⋯ Elderly patients had a significantly lower proportion of nonurgent diagnoses (19.4 vs. 32.0%) than the nonelderly patients. Use of the ED by elderly patients is different from nonelderly patients in that they are more likely to have a serious medical illness. There is little evidence that elderly persons use the ED for primary self-care or social problems.
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A continuous observation time study was used to track 1,568 patients through various stages of emergency department care in order to identify sources of delay. Patients initially were assigned to one of four categories of decreasing acuity, and flow profiles were compared for each category. Patients with lowest acuity level experienced long delays in moving through the ED, although the actual evaluation and treatment time was brief. ⋯ The most critical patients moved most quickly but with a brief evaluation and treatment time due to a rapid disposition from the ED or death. This relationship suggests an emergency care system that is oriented toward the efficient care of high-acuity patients but that is less effective for low-acuity patients. This occurs despite the fact that low-acuity patients comprise the vast majority of the ED census, and represent a group for whom delay is a frequent source of patient dissatisfaction.
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In a pilot project sponsored by the California State Emergency Medical Services Authority, validated, verifiable criteria were developed for the vertical categorization of hospital emergency services in 11 different groupings of medical and surgical emergencies. We describe the development of an assessment process and categorization criteria to identify the most appropriate receiving facility for interfacility transfer and, in selected instances, field triage of patients with different levels of severity of illness or injury. We propose that this facility assessment project be used in the critical care planning process for the eventual vertical categorization of hospital emergency services in California and as a template for similar projects in other states.