Articles: emergency-services.
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Emerg Med Australas · Apr 2019
Multicenter Study Comparative StudyEffect of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer on pulmonary embolism diagnosis, scan rates and diagnostic yield.
To assess the association between the use of a flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer and subsequent imaging and yield rates of computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion scans being ordered in the ED for the assessment of pulmonary embolism. ⋯ The introduction of a clinical flowchart incorporating Wells score, PERC rule and age-adjusted D-dimer was associated with an increase in ED computed tomography pulmonary angiogram and nuclear medicine ventilation perfusion yield rate from 9.9% to 16.5% across the three enrolment hospitals when investigating possible pulmonary embolism. This corresponded to a 40% relative reduction in pulmonary embolism imaging. Diagnosis rates remained unchanged and no cases of missed pulmonary embolism attributable to the flowchart were identified.
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Multicenter Study Observational Study
Emergency Department Crowding Is Associated With Delayed Antibiotics for Sepsis.
Barriers to early antibiotic administration for sepsis remain poorly understood. We investigated the association between emergency department (ED) crowding and door-to-antibiotic time in ED sepsis. ⋯ ED crowding was associated with increased sepsis antibiotic delay. Hospitals must devise strategies to optimize sepsis antibiotic administration during periods of ED crowding.
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Multicenter Study Comparative Study
The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients.
To determine whether rapid polymerase chain reaction (PCR) testing for influenza and respiratory syncytial viruses (RSV) in emergency departments (EDs) is associated with better patient and laboratory outcomes than standard multiplex PCR testing. ⋯ Rapid PCR testing of ED patients for influenza virus and RSV was associated with better outcomes on a range of indicators, suggesting benefits for patients and the health care system. A formal cost-benefit analysis should be undertaken.
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Emerg Med Australas · Apr 2019
Multicenter StudyValue of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries.
To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps. ⋯ Bicycle injuries carry a considerable burden to the ED and the incidence of presentations appears to be rising. The current triage data, designed to provide a rapid assessment for medical urgency, are limited to describing broad demographics, trends and causes.
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Emerg Med Australas · Apr 2019
Multicenter StudyLonger time to transfer from the emergency department after bed request is associated with worse outcomes.
To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. ⋯ Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.