Annals of emergency medicine
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We investigate the effect of admission process policies on patient flow in the emergency department (ED). ⋯ An efficient admission process can reduce waiting times for both admitted and discharged ED patients. This study contributed to demonstrating the potential value of leveraging admission process policies and developing a framework for pursuing these policies.
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Review Meta Analysis
What Are the Most Clinically Useful Cutoffs for the Alvarado and Pediatric Appendicitis Scores? A Systematic Review.
The objective of this study is to systematically review the accuracy of the Alvarado score and Pediatric Appendicitis Score and to identify optimal cutoffs for low- and high-risk populations. ⋯ For children with a pretest probability of acute appendicitis of 60% or less, an Alvarado score below 4 rules out the diagnosis; this is also true for a score less than 5 if the pretest probability is up to approximately 40%. In adults with a pretest probability greater than or equal to 60%, an Alvarado score of 8 or higher rules in the diagnosis, whereas one of 9 or higher rules in the diagnosis at pretest probabilities greater than or equal to 40%. The Pediatric Appendicitis Score did not identify clinically useful low- or high-risk groups at typical pretest probabilities.
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We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care. ⋯ Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug use, and depression and correlated with previous ED service use among female youths. ED interventions should consider addressing these associated health conditions, as well as improving screening protocols to address dating violence among male and female youths.
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National guidelines recommend annual Chlamydia trachomatis and Neisseria gonorrhoeae screening for sexually active youth at risk for infection. These infections have serious sequelae in women if untreated, and methods to improve testing are needed. We hypothesize that an electronic method of identifying at-risk youth will significantly increase testing for these sexually transmitted infections during emergency department (ED) visits. ⋯ Sexually transmitted infection testing in the ED significantly increased during ACASI use and diminished after withdrawal. The ACASI was well accepted by youth and holds promise for enhancing sexually transmitted infection testing in the ED.
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We describe the current state of emergency department to inpatient handoffs and assess handoff best practices between emergency physicians and hospitalist medicine physicians. ⋯ To our knowledge, this is the largest multispecialty survey to date, including both resident and attending physicians in emergency medicine and hospital medicine. Standardized tools are rarely used and training of residents in this critical task is uncommon. Physicians in both specialties agree on the important content and structure of handoff, including the ideal situation of face-to-face bedside discussion. A curriculum and assessment tool for this practice should be developed.