Internal and emergency medicine
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Healthcare systems are continuously evolving to respond to new geodemographic demands, among other challenges. At the forefront of this exercise of malleability, Emergency Departments (EDs) are often put to test as the default access point, while the rest of the system takes time to adapt. ⋯ Understanding how EDs are structured within their respective healthcare system provides a unique lens through which areas of improvement can be assessed. This paper discusses solutions to improve the overall structure of the healthcare system to help improve responsiveness, reduce relegation of tasks to the ED, and help improve working conditions and wellbeing for EPs.
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The progressive reduction of acute care beds will necessitate hospital admission in medical settings solely for acutely ill patients requiring urgent organ support. Early stabilization of the acute condition, potentially through an appropriate treatment unit, may not only improve short-term patient outcomes but also reduce the length of hospital stay. To determine if stabilization of the acute condition in an intermediate care unit (IMCU) is associated with improved patient outcomes and reduced in-hospital stay. ⋯ Meanwhile, for 30-day mortality, patient stabilization was found to be protective with an odds ratio of 0.11 (95% CI 0.04-0.29, p < 0.001). Early stabilization is associated with lower 30-day mortality and shorter lengths of stay. Treatment in an IMCU shows higher rates of 72-h stabilization.
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It is crucial to identify high-risk patients with infectious conditions for appropriate management. We previously found that inflammatory markers added value to vital signs for predicting mortality in patients with suspected infection. In this study, the aim was to externally validate the added value of the inflammatory markers and to develop a new prediction model. ⋯ The newly developed model showed a higher c-index than the qSOFA model [0.756 (95% CI 0.726-0.786) vs. 0.663 (0.630-0.696), p < 0.001]. Using the new model, 9.0% of patients who died were correctly reclassified compared with the qSOFA model at the threshold of 10% mortality risk. The new model including these markers showed potential to outperform the qSOFA model.