Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Demand for emergency care is rising throughout the western world and represents a major public health problem. Increased reliance on professionalized health care by the public means that strategies need to be developed to manage the demand safely and in a way that is achievable and acceptable to both consumers of emergency care, but also to service providers. In the United Kingdom, strategies have previously been aimed at managing demand better and included introducing new emergency services for patients to access, extending the skills within the existing workforce, and more recently, introducing time targets for emergency departments (EDs). This article will review the effect of these strategies on demand for care and discuss the successes and failures with reference to future plans for tackling this increasingly difficult problem in health care.
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Multicenter Study
Emergency severity index triage system correlation with emergency department evaluation and management billing codes and total professional charges.
All services provided by physicians to patients during an emergency department (ED) visit, including procedures and "cognitive work," are described by common procedural terminology (CPT) codes that are translated by coders into total professional (physician) charges for the visit. These charges do not include the technical (facility) charges. The objectives of this study were to characterize associations between Emergency Severity Index (ESI) acuity level, ED Evaluation and Management (E&M) billing codes 99281-99285 and 99291, and total ED provider charges (sum of total procedure and E&M professional charges). Secondary objectives were to identify factors that might affect these associations and to evaluate the performance of ESI and identified variables to predict E&M code and average total professional charges. ⋯ A moderate, nonlinear correlation exists between ESI acuity levels and ED E&M billing codes. Increasing age affects this correlation. Race and E&M code affect the correlation between ESI level and total professional charges. As such, basic triage data can be used to estimate E&M code and total professional charges. Future studies are needed to validate these findings across other institutional settings.
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The difficult intravenous access (DIVA) score, a proportionally weighted four-variable (vein palpability, vein visibility, patient age, and history of prematurity) clinical rule, has been developed to predict failure of intravenous (IV) placement in children. This study sought to externally validate and refine the DIVA score. ⋯ This study validated the previously derived four-variable DIVA score. A simpler three-variable rule was as predictive of failed IV placement on first attempt as the four-variable rule. Validation in nonpediatric EDs is needed to thoroughly evaluate generalizability.
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Facebook and social media networking applications use is ubiquitous across all ages and cultures. Facebook has finally begun to appear in the medical-scientific press. Today's medical literature is focused on concerns of professionalism in young health care practitioners vis-à-vis the lay public as they continuously expose themselves through this online social medium. ⋯ Nobody so far has considered the opposite issue: that of physician invasion of privacy by "looking-up" a patient on Facebook during clinical practice for purposes of history-taking or diagnostic clues in situations where patients are too ill to provide needed information. We need to consider the ethical implications of privacy invasion in the current era of information technology. We need to acquire and maintain a certain level of "social media competency" to better debate the issues around Facebook and how we integrate on-line content with our patients' histories of present illness (HPI) or past medical histories (if at all).
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This lecture can be viewed in its entirety online by visiting http://vimeo.com/24148123.