Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital. ⋯ Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.
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The objective was to assess in a pediatric emergency department (ED) the reliability of the color analog scale (CAS) for acute pain assessment, overall and between traumatic and nontraumatic pain etiology. ⋯ The color analog scale is both a valid and a reliable self-reporting tool in the assessment of acute pain in children.
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Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts. ⋯ These quality indicators will help researchers and clinicians target quality improvement efforts. The next steps will be to test the feasibility of capturing the quality indicators in existing medical records and to measure the extent to which each quality indicator is successfully met in current emergency practice.
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Although the U. S. population continues to become more diverse, ethnic and racial health care disparities persist. ⋯ The objective of the discussion was to develop strategies to help EM residency programs examine and improve diversity in their respective institutions. Specific recommendations focus on URG applicant selection and recruitment strategies, cultural competence curriculum development, involvement of URG faculty, and the availability of institutional and national resources to improve and maintain diversity in EM training programs.
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Editorial Comment
Democracy, ambiguity, scrutiny, and evidence-based medicine.