Annals of emergency medicine
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WHAT IS ALREADY KNOWN ON THIS TOPIC: Emergency department (ED) crowding may result in delays in the administration of medication such as antibiotics for pneumonia. WHAT QUESTION THIS STUDY ADDRESSED: Does crowding cause delays in treatment for pain? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In this retrospective analysis of 13,578 patients treated at a single inner-city ED, patients with severe pain were slightly less likely to receive pain medications quickly when the ED volume increased. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Crowding may delay the administration of pain medication in some patients. Standing orders for the administration of pain medication might mitigate such delays.
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Emergency department patient preferences for boarding locations when hospitals are at full capacity.
Admitted patients are frequently boarded in emergency departments (EDs) when hospitals are at full capacity, which lessens the ED's ability to treat new patients. One alternative is to board admitted patients in inpatient hallways. We assess ED patient preferences for boarding location. ⋯ When hospitals are at full capacity, patients would rather board in inpatient hallways than ED hallways.
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Inhaled bronchodilators are often used in the emergency department (ED) before a definitive diagnosis is made. We evaluated the association between inhaled bronchodilators and outcomes in acute decompensated heart failure patients without chronic obstructive pulmonary disease. ⋯ Many acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease receive inhaled bronchodilators. Bronchodilator use was associated with a greater need for aggressive interventions and monitoring, and this may reflect an adverse effect of bronchodilators or it may be a marker for patients with more severe disease.
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Review Comparative Study
Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy?
The emergency management of primary spontaneous pneumothorax is controversial. This evidence-based emergency medicine review evaluates the existing evidence about the efficacy and safety of needle aspiration in comparison to tube thoracostomy for management of primary spontaneous pneumothorax. ⋯ The existing evidence indicates that needle aspiration is at least as safe and effective as tube thoracostomy for management of primary spontaneous pneumothorax. Additionally, needle aspiration carries the benefit of fewer hospital admissions and shorter length of hospital stay.
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Multicenter Study Comparative Study
The emergency department occupancy rate: a simple measure of emergency department crowding?
We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. ⋯ The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.