Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Marked reduction in length of stay for patients with psychiatric emergencies after implementation of a comanagement model.
Patients with psychiatric emergencies often spend excessive time in an emergency department (ED) due to limited inpatient psychiatric bed capacity. The objective was to compare traditional resident consultation with a new model (comanagement) to reduce length of stay (LOS) for patients with psychiatric emergencies. The costs of this model were compared to those of standard care. ⋯ A comanagement model was associated with a marked reduction in the LOS for this patient population.
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Comparative Study
End-of-life decision-making for patients admitted through the emergency department: hospital variability, patient demographics, and changes over time.
Early studies suggest that racial, economic, and hospital-based factors influence the do-not-attempt-resuscitation (DNAR) status of admitted patients, although it remains unknown how these factors apply to patients admitted through the emergency department (ED) and whether use is changing over time. ⋯ While statewide rates of DNAR use have increased over time among patients admitted through the ED, there is variable penetrance of this practice by hospital types, patient race, and patient ethnicity. These patterns may suggest barriers to end-of-life discussions, differences in hospital case mix, and variation in cultural or institutional beliefs and practices.
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Comparative Study
Posted emergency department wait times are not always accurate.
Hospitals around the United States are advertising emergency department (ED) wait times. The objective was to measure the difference between publicly posted and actual ED wait times and to compare these between ED site volumes. ⋯ In one hospital system, publicly posted ED wait times show better accuracy in EDs that see 2,000 or fewer patients per month and less accuracy for an ED that sees 5,000 patients per month, likely due to flow confounders.
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Multicenter Study Comparative Study Clinical Trial
The use of delayed telephone informed consent for observational emergency medicine research is ethical and effective.
The objective was to describe the rate of successful consent using an altered (deferred telephone) consent process in emergency department (ED) patients. ⋯ The authors achieved a very high rate of successful telephone follow-up in this predominantly older ED population. Obtaining consent to participate in a research study using a deferred telephone contact process was effective and well received by both subjects and surrogates. IRBs should consider deferred telephone consent for minimal-risk studies requiring telephone follow-up, as opposed to a consent process requiring written documentation at the time of initial ED visit.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines.
The objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil. ⋯ No difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small pilot study. PS using propofol only without supplemental opioid did not appear to induce markers of physiologic stress in this small pilot study.