Advanced emergency nursing journal
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This study aimed to describe characteristics, outcomes, and post-emergency department (ED) departure medical requirements of patients who did not wait (DNW) or left against medical advice (LAMA) after presenting to an Australian hospital ED over a 6-month period. This was a prospective cohort follow-up study. Children and adults were compared in terms of ED characteristics and outcomes. ⋯ One in four of the DNW/LAMA patients were children (<16 years). Most (87%) waited longer than the recommended time before leaving the ED, the majority (56%) sought care elsewhere, and some (n = 174, 13%) re-presented to the ED within 7 days; 20 of those required hospital admission. Strategies addressing front-end ED systems are required to mitigate the proportion of patients who DNW/LAMA.
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Case Reports
The differential diagnosis of syncope: a guide for emergency department advanced practice nurses.
Syncope is common in patients presenting in the emergency department, and it is essential that advanced practice nurses (APNs) be able to quickly and efficiently risk-stratify these patients. The importance of a thorough and accurate history and physical examination cannot be understated in diagnosing the pathology of syncope. Although vasovagal syncope is the most common cause of syncope, it is important to rule out the life-threatening causes of syncope first. ⋯ APNs can also decide whether an inpatient admission is warranted or whether the patient can be safely discharged with outpatient follow-up. The importance of the history and physical examination as the best tool that APNs can use has been highlighted. Finally, implications for APNs in treating patients presenting with syncope are discussed.
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The goal of this project was to assess perceptions of medication reconciliation from health care professionals who perform this task. Specific areas of interest included the perceived amount of time spent on medication reconciliation; process complexity; and effectiveness of the current process. Opinions concerning the use of alternative processes were also solicited. ⋯ Participants felt that emergency triage may not be the most ideal time in which to perform medication reconciliation, and they expressed concerns about accuracy of these medication lists. Whereas some were interested in the possibility of using a patient medication database and expected that it would improve accuracy and save time, others were less open to a perceived additional step. Participants provided suggestions for changes in the current medication reconciliation process that they feel could improve patient satisfaction and increase efficiency.