Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Institute of Medicine (IOM)'s "Future of Emergency Care" report recommended the categorization and regionalization of emergency care, but no uniform system to categorize hospital emergency care capabilities has been developed. The absence of such a system limits the ability to benchmark outcomes, to develop regional systems of care, and of patients to make informed decisions when seeking emergency care. The authors sought to pilot the deployment of an emergency care categorization system in two states. ⋯ Using this categorization system, fewer than half of all EDs provide advanced or comprehensive emergency care. While the majority of the population has access to advanced or comprehensive care within an hour, a significant portion (25%) does not. This article describes how an ED categorization scheme could be developed and deployed across the United States. There are implications for prehospital planning, patient decision-making, outcomes measurement, interfacility transfer coordination, and development of regional emergency care systems.
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The objective was to derive and validate a novel queuing theory-based model that predicts the effect of various patient crowding scenarios on patient left without being seen (LWBS) rates. ⋯ This novel queuing theory-based model predicts the effect of patient arrivals, treatment time, and ED boarding on the rate of patients who LWBS at one institution. More studies are needed to validate this model across other institutions.
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The authors sought to describe the demographic and clinical characteristics of interhospital transfers from U.S. emergency departments (EDs) along with the primary reasons for transfers. ⋯ Transfer of ED patients was relatively rare, but was more common among specific, potentially high-risk populations. Diagnostic testing, including advanced imaging, was common prior to transfer. A majority of transfers were for reasons indicating limited resources or expertise at the referring facility.
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Emergency physicians (EPs) frequently evaluate patients at risk for diseases that cause optic disc swelling, and they may encounter conditions that make traditional fundoscopy difficult or impossible. The objective was to assess whether EP-performed point-of-care (POC) ultrasound (US) could accurately assess swelling of the optic disc. ⋯ These data suggest that EP-performed POC US can detect clinically apparent optic disc swelling. Because sonography can be performed readily at the bedside, even in cases where fundoscopy is difficult or impossible, this technique may prove to be a valuable tool for the assessment of optic disc swelling in the emergency department (ED).
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Studies examining the relationship between obesity and acute coronary syndrome (ACS) have been limited to patients with confirmed diagnoses. The authors sought to determine the relationship between body mass index (BMI) and 30-day cardiovascular events in emergency department (ED) patients with potential ACS. ⋯ Among patients who present to the ED with potential ACS, BMI is not associated with higher risk of cardiovascular outcomes at 30 days.