Annals of emergency medicine
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In July 1988, our emergency department adopted a policy of refusing to treat patients in the ED if they failed to have what was considered an emergency condition. Screening examinations were performed by triage nurses to determine whether patients were eligible to be seen in the ED. Patients whose vital signs fell within specific categories and who had one of 50 minor chief complaints were refused care in the ED and referred to off-site clinics. ⋯ Follow-up letters and telephone calls to their clinics identified no patients who needed retriage to an ED, and only 54 patients (1.3%) complained about their referral out of the ED. Only 42 patients returned to the ED within 48 hours of initial triage, and none had a deterioration of their condition. In conclusion, a selective triage system may be used to effectively decompress an ED, although further study is needed to identify potential rare adverse outcomes.
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The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. ⋯ However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.
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Prehospital care delivered by multiple agencies and their paramedics in a suburban emergency medical services (EMS) system was compared to assess the impact of a receiving hospital quality assurance audit on paramedic and agency performance. A committee of physicians, nurses, and paramedics developed performance criteria based on a county EMS protocol. Run tapes were reviewed to assess accuracy of runsheets. ⋯ A mean deficiency per run of 0.39 +/- 0.55 was found, with four paramedics performing more than two standard deviations from the mean. This receiving hospital EMS quality assurance audit has helped document problems in agency procedure performance and individual paramedic performance. It also has improved compliance with county protocol on patients delivered to our institution.
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Physician assistants (PAs) specially trained in emergency medicine can be used effectively to work with emergency medicine physicians to provide efficient and expedient high-quality patient care. The concept of using PAs in the emergency department is reviewed, and items of concern to professionals who are reluctant to use PAs are discussed. ⋯ The PA program at Beth Israel Medical Center is used as a case study to demonstrate the use and integration of the PA within the division of emergency services. Although a well-trained emergency physician is the gold standard for quality patient care, cost-effective quality care for certain patient complaints can be rendered acceptably by others.
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The records of all patients who presented to a Level 1 trauma center during a two-year period for whom a prehospital cricothyrotomy was attempted or ordered were reviewed. Twenty patients met the study criteria. The average age was 37 years (range, 11 to 65 years). ⋯ These preliminary findings demonstrate that prehospital cricothyrotomy is being used chiefly in massively injured patients who are already beyond recovery. It is thus difficult to assess whether the procedure is either safe or effective. There is a need for further investigation to determine whether prehospital cricothyrotomy has any beneficial effect on outcome and, if so, in what setting.(ABSTRACT TRUNCATED AT 250 WORDS)