Pediatric emergency care
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Pediatric emergency care · Dec 1986
Utilization of emergency services among patients of a pediatric group practice.
Pediatric group practices in university hospitals provide primary care to children who are often from indigent families. Those practices that attempt to provide care in a continuous way often encounter difficulty in attempting to change their patients' patterns of emergency department utilization. This study attempts to define the relationship between patient characteristics such as access to a telephone and inappropriate utilization of the emergency department. ⋯ However, within the cohort of emergency department utilizers, phone access was not a predictor of use. Of those who used the emergency department, babies and young children and those of indigent status were more likely to inappropriately access care than were older children and those at a higher socioeconomic level. We conclude that the demographic information of clients in a pediatric group practice can be utilized to predict inappropriate utilization of emergency department services and that this information can be used to implement programs to help foster continuity of care.
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Pediatric emergency departments were surveyed by mail to determine the following patient and physician characteristics: census, triage classification, and staffing characteristics. The average number of patient visits per department per year was 44,615 (SD +/- 15,650). Of these, the mean percentage triaged as emergent, urgent, and nonurgent was 14.6 (SD +/- 13.4%), 35.4 (SD +/- 13.1%), and 52.2 (SD +/- 8.7%), respectively. ⋯ Fifty-nine (91%) of the physicians were pediatric board certified, and five (7.6%) were emergency medicine board certified. Academic standing, salaries, clinical research requirements, teaching responsibilities, and average patient care hours were also reviewed. From these data, suggestions for the management of patient care, teaching, and clinical research are presented.
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Fifty-six hypothermic infants (23 to 34 degrees C), aged four to 113 days, admitted during the winter months over a three-year period are reported. Low weight and malnutrition were frequent findings on admission. One or more severe associated disturbances, including metabolic abnormalities, bleeding tendency, infection, and respiratory failure were observed in most cases. ⋯ Of the three who died, none was rapidly warmed, and two of them had severe underlying central nervous system infection. Hypothermia of infancy and the associated disturbances are treatable today, on condition that modern medical facilities are available. It appears that the warming method has been overly stressed.
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Because scald burns are reported to be the leading cause of burn injuries to children, little is written about other etiologies of burn injury in the pediatric literature. To test the hypothesis that burns from other etiologies are more serious and require longer hospitalizations than scald burns, a retrospective chart review was undertaken. The charts of all patients less than 16 years of age who were admitted to Harborview Medical Center Burn Unit in the years 1979 to 1984 were reviewed. ⋯ However, 46% of the burns resulting in admission to our burn center were from etiologies other than scald injury. There was no significant correlation between etiology of the burns and length of hospital stay, rate of infection, or need for excision and grafting. Thermal injuries to children from any etiology are serious; pediatric health care providers should be aware that children may be burned in a variety of ways and should direct some of their well-child visit time to the topic of burn prevention in the home.