Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine whether patient clinical and socioeconomic characteristics predict patient delay in coming to the emergency department (ED). ⋯ A patient's decision to delay coming to the ED often reflects a belief that his or her illness is either self-limited or not serious. The decision to delay correlates with patient characteristics and access to a regular physician. The correlates of delay in seeking ED care may depend on the delay measure used. Better understanding of patients at risk for delaying care may influence interventions to reduce delay.
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To develop a multivariable model predicting the level of care required by pediatric patients for use as a risk-adjustment tool in the evaluation of emergency medical services for children. ⋯ A model based on easily and routinely measured variables can accurately predict the level of care rendered in the PED. The predicted probabilities from such a model correlate well with other outcomes of care and may be useful in adjusting for differences in risk when evaluating quality of care.
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To implement a new five-level emergency department (ED) triage algorithm, the Emergency Severity Index (ESI), into nursing practice, and validate the instrument with a population-based cohort using hospitalization and ED length of stay as outcome measures. ⋯ Triage nurses at these two hospitals successfully implemented the ESI algorithm and provided useful feedback for further refinement of the instrument. Emergency Severity Index triage reproducibly stratifies patients into five groups with distinct clinical outcomes.
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To define a quality assurance instrument to evaluate errors in diagnostic processes made by physicians in the emergency department (ED). ⋯ A two-tiered evaluation of ED records selected by inconsistent initial and final diagnoses can be used reliably to screen for errors in the diagnostic process made by emergency physicians (EPs). The rate of physician error contributing to a misdiagnosis is very low, suggesting that EPs are delivering quality patient care.
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Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP)-the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. ⋯ A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes.