Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Multicenter Study
National Cost Savings From Observation Unit Management of Syncope.
Syncope is a frequent emergency department (ED) presenting complaint and results in a disproportionate rate of hospitalization with variable management strategies. The objective was to estimate the annual national cost savings, reduction in inpatient hospitalizations, and reduction in hospital bed hours from implementation of protocolized care in an observation unit. ⋯ The potential national cost savings for managing selected patients with syncope in a dedicated observation unit is substantial. Syncope is one of many conditions suitable for care in an observation unit as an alternative to an inpatient setting. As pressure to decrease hospital length of stay and bill short-stay hospitalizations as observation increases, syncope illustrates the value of observation unit care.
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Asthma is a common chronic respiratory condition, and exacerbations may cause individuals to seek care in emergency departments (EDs). This study examines the monthly patterns of asthma presentations to EDs in Alberta, Canada. ⋯ Rates of ED presentations for asthma have been declining in this province during the past decade. The reasons for this decline warrant further exploration. The SARIMA models quantified the temporal patterns and may be helpful for planning research and health care service needs.
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Topical Antibiotic Ointment Versus Silver-containing Foam Dressing for Second-degree Burns in Swine.
Second-degree burns are very common but their management is controversial. These burns may be treated with either topical antimicrobial agents or advanced occlusive dressings; however, there is no established treatment comparator for preclinical studies. This study was designed to determine which of two commonly used comparator therapies (a silver-containing advanced dressing or a topical antibiotic ointment) resulted in faster reepithelialization and less scarring. The hypothesis was that second-degree burns treated with a topical antimicrobial ointment would heal faster and with less scarring than those treated with a silver-containing occlusive foam dressing in a porcine model. ⋯ In this model of excised deep partial-thickness burns, a triple-antibiotic ointment enhanced reepithelialization and reduced scar depth and contraction compared with a silver-based foam dressing. This triple-antibiotic ointment should be considered as a control for studies evaluating novel topical burn therapies.
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Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting, and they affect more than 300,000 adult Canadians. The aims of this study were to examine temporal and geographic trends in emergency department (ED) presentations made by adults (age ≥ 35 years) for AFF in Alberta, Canada, from 1999 to 2011. Statistical disease cluster detection techniques were used to identify geographic areas with higher numbers of individuals presenting with AFF and higher numbers of ED presentations for AFF than expected by chance alone. Geographic clusters of individuals with stroke or heart failure follow-up within 365 days of ED presentations for AFF were also identified. ⋯ This population-based study spanned 12 fiscal years and showed variations in the number of people presenting to EDs for AFF and the number of ED presentations for AFF over geography. The potential clusters identified may represent geographic areas with higher disease severity or a lower availability of non-ED health services. The clusters are not all likely to have occurred by chance, and further investigation and intervention could occur to reduce ED presentations for AFF.
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Review
Effectiveness and Safety of Short-stay Units in the Emergency Department: A Systematic Review.
Overcrowding is a serious and ongoing challenge in Canadian hospital emergency departments (EDs) that has been shown to have negative consequences for patient outcomes. The American College of Emergency Physicians recommends observation/short-stay units as a possible solution to alleviate this problem. However, the most recent systematic review assessing short-stay units shows that there is limited synthesized evidence to support this recommendation; it is over a decade old and has important methodologic limitations. The aim of this study was to conduct a more methodologically rigorous systematic review to update the evidence on the effectiveness and safety of short-stay units, compared with usual care, on hospital and patient outcomes. ⋯ Insufficient evidence exists to make conclusions regarding the effectiveness and safety of short-stay units, compared with inpatient care.