Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). ⋯ With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate.
-
Pediatric emergency department crowding is associated with a lower likelihood of hospital admission.
Emergency department (ED) crowding may affect disposition decision-making. The objective was to measure the effect of ED crowding on probability of admission and return visit to the ED after discharge. ⋯ Increasing ED crowding is associated with a lower likelihood of hospital admission and lower frequency of return visits within 48 hours.
-
Ultrasound (US) has well-documented utility in critical procedures performed in the emergency department. It has been described as a "skill integral to the practice of emergency medicine" in the 2007 Model of Clinical Practice of Emergency Medicine. One of the ideal uses for US in critical care may be in the performance of emergent cricothyroidotomy. To the best of our knowledge there is currently no description of how to perform an US-guided open cricothyroidotomy in the literature. ⋯ Ultrasound-guided bougie-assisted cricothyroidotomy is a novel technique that may be beneficial in emergent open cricothyroidotomy. The data suggest that this technique is rapid, with a median time to completion of 26.2 seconds. The data also suggest that the procedure may have a low failure rate, with 20 of 21 cadavers undergoing successful cricothyroidotomy.
-
This study aimed to investigate whether early epinephrine administration in out-of-hospital cardiopulmonary arrest (OHCA) patients was associated with improved outcomes and to address the selection bias inherent in observational studies (more severe cases are more likely to receive epinephrine). ⋯ Early epinephrine administration may be associated with higher rates of intact neurologic survival and any survival in adult bystander-witnessed OHCA patients. This article provides a potential method to address the selection bias inherent in observational studies that examine the effects of drug administration in OHCA patients.