The American journal of emergency medicine
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In an effort to compensate for crowding, many emergency departments (EDs) evaluate and treat patients in nontraditional settings such as gurneys in hallways and conference rooms. The impact of this practice on ED evaluation time is unknown. ⋯ Use of nontraditional beds is associated with increases in mean ED evaluation time; however, these increases are small and may be further minimized by restricting the use of nontraditional beds to patients with specific chief complaints. Nontraditional beds may have a role in improving ED throughput during times of crowding.
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The objective of this study is to determine the number of primary stroke centers (PSCs) that exist concurrently (synergic relationship) with designated higher level trauma centers (level I or level II trauma centers) and associated characteristics. ⋯ Despite evidence of higher capability among institutions with coexisting PSC-trauma centers, two thirds of PSCs are in hospitals without advanced trauma systems. These findings have implications for establishing stroke systems in the United States.
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The purpose of this study is to develop and validate the excess mortality ratio-based Emergency Severity Index (EMR-ESI) that feasibly and objectively assesses the severity of emergency department (ED) patients based on their chief complaints. ⋯ The EMR-ESI was notably useful in predicting hospital mortality and the admission of emergency patients.
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The objective of this study is to evaluate the accuracy of emergency providers (EPs) of various levels of training in determination of gestational age (GA) in pregnant patients using bedside ultrasound measurement of crown-rump length (CRL). ⋯ Emergency providers can quickly and accurately determine GA in first-trimester pregnancies using bedside ultrasound to calculate the CRL. Emergency providers should consider using ultrasound to calculate the CRL in patients with first-trimester bleeding or pain because this estimated GA may serve as a valuable data point for the future care of that pregnancy.
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The measurement of cardiac troponin concentrations in the blood is a key element in the evaluation of patients with suspected acute coronary syndromes, according to current guidelines, and contributes importantly to the ruling in or ruling out of acute myocardial infarction. The introduction of point-of-care testing for cardiac troponin has the potential to reduce turnaround time for assay results, compared with central laboratory testing, optimizing resource use. Although, in general, many point-of-care cardiac troponin tests are less sensitive than cardiac troponin tests developed for central laboratory-automated analyzers, point-of-care systems have been used successfully within accelerated protocols for the reliable ruling out of acute coronary syndromes, without increasing subsequent readmission rates for this condition. ⋯ Accordingly, the point-of-care approach has not been shown to be cost-effective relative to central laboratory testing. Modeling studies suggest, however, that reengineering overall procedures within the emergency department setting, to take full advantage of reduced therapeutic turnaround time, has the potential to improve the flow of patients through the emergency department, to shorten discharge times, and to reduce cost. To properly evaluate the potential contribution of point-of-care technology in the emergency department, including its cost-effectiveness, future evaluations of point-of-care platforms will need to be embedded completely within a local decision-making structure designed for its use.