Articles: emergency-services.
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To examine if an ED interprofessional team ("ED1Team") could safely decrease hospital admissions among older persons. ⋯ ED1Team consultation was associated with a decreased hospital admission rate in older ED patients. It was associated with a slightly longer ED length-of-stay and subsequent early hospitalizations. Given that even a small increase in freed hospital beds would release some of the pressure on an overextended healthcare system, these results suggest that upscaling of the intervention might procure systems-wide benefits.
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Comparative Study
Comparative safety and efficacy of a hybrid intravenous and oral diltiazem protocol for acute rate control in the emergency department.
Intravenous diltiazem has experienced numerous supply shortages over the past few years. The purpose of this study was to compare the safety and efficacy of a traditional diltiazem intravenous bolus and continuous infusion protocol to a diltiazem intravenous bolus and oral maintenance protocol for acute rate control in the emergency department. ⋯ Results of this study demonstrated no difference in acute rate control when using a hybrid IV and oral diltiazem protocol, compared to a traditional IV bolus and infusion strategy. This information supports the further use of a hybrid diltiazem IV and oral protocol, which provides increased flexibility during shortages of either medication.
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Emerg Med Australas · Oct 2024
Observational StudyComputed tomography pulmonary angiogram ordering, adherence to decision rules and yield in the emergency department: An observational study.
Pulmonary embolism (PE) frequently requires diagnosis through CT pulmonary angiogram (CTPA). Appropriate application of evidence-based clinical decision tools can reduce unnecessary CTPAs. This study assessed adherence to and the efficacy of various aspects of the Queensland Health suspected PE diagnostic pathway, including Wells score, PE rule out criteria (PERC) and age-adjusted D-dimer interpretation. ⋯ Guideline adherence can be improved, and adherence to existing clinical decision tools may reduce unnecessary CTPA ordering and increase diagnostic yield. The use of the age-adjusted D-dimer had good sensitivity, whereas the new PTP approach will require further prospective research.
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Emerg Med Australas · Oct 2024
Summer alcohol-related emergency department workload and occupancy in Australasia 2019-2022.
Alcohol is a major public health issue and the ACEM funds regular 'snapshot' surveys of the prevalence of alcohol-related presentations in EDs. The present study uses these data to investigate ED occupancy and alcohol- and methamphetamine-related presentations at the time of the COVID-19 pandemic. ⋯ The present study demonstrates that the COVID-19 pandemic did not affect summer alcohol-related ED presentations in Australasia but was associated with an unsustainable increase in ED crowding.
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Comparative Study Observational Study
Downstream Emergency Department and Hospital Utilization Comparably Low Following In-Person Versus Telemedicine Primary Care for High-Risk Conditions.
Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. ⋯ Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.