Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Does Shared Decision-Making actually occur in the ED? Looking at it from the patients' perspective.
We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives. ⋯ Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
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Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs). ⋯ An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses.
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Pediatric seizures are commonly encountered in emergency medical services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement. ⋯ Compliance is suboptimal, varying with patient age, race, and EMT-P presence. Testing increases when antiepileptic drugs are used. Hypoglycemia in tested patients was infrequent; however, proper treatment for hypoglycemic seizures will not be delivered if testing does not occur. It is worthwhile examining the utility of routine testing in this setting; however, until such time as protocols are revised, regional EMS administration should focus on education and uniform compliance with state protocols.