Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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This article uses a case report and discussion to demonstrate the concept of active and latent failures, and the "systems approach" to the reduction of adverse events in medicine. The case involves an inadvertently misplaced and retained guidewire during femoral vein catheterization using the Seldinger technique, and the subsequent failure to identify the guidewire in the chest despite several chest radiographs and a computed tomography (CT) scan read by radiologists, emergency physicians, and intensivists. This event reveals active failures in the performance of the Seldinger technique, latent failures in the design of the catheter kit, and problems with the current system of interpretation of radiographs. The authors conclude that the design of the catheter kit and the Seldinger technique should be critically examined from a human factors standpoint and that radiographic interpretation is still heavily subject to human error.
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As an initial step in disseminating an emergency department (ED)-based quality improvement program (QIP) to improve antibiotic prescribing for patients with acute respiratory infections, the authors conducted a nationwide survey to assess the value and feasibility of the QIP. ⋯ Many EDs identify barriers to implementing an antibiotic QIP. Perceived and real barriers are important factors to consider in translating successful QIPs into routine clinical practice.
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Randomized Controlled Trial Comparative Study
Intensive intervention improves primary care follow-up for uninsured emergency department patients.
To test an intervention designed to improve primary care use and decrease emergency department (ED) utilization for uninsured patients using the ED. ⋯ This project has demonstrated that it is possible to improve primary care follow-up for uninsured ED patients.
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Controlled Clinical Trial
The effect of financial incentives on adherence with outpatient human immunodeficiency virus testing referrals from the emergency department.
Undiagnosed human immunodeficiency virus (HIV) infection is not uncommon among patients who seek care in urban inner-city emergency departments (EDs). The optimal method for providing appropriate HIV counseling, testing, and referral in this setting is unclear. A previous evaluation of an outpatient referral system for HIV testing among patients seen in the ED demonstrated that only 11% returned to be tested; of those tested, 7% were seropositive. The purpose of this study was to evaluate the effect of a financial incentive on the proportion of referred ED patients who completed outpatient HIV counseling and testing. ⋯ The use of a modest financial incentive increased the proportion of patients who completed HIV counseling and testing after being referred from the ED. It is unclear whether the use of a financial incentive increases the identification of HIV-infected patients unaware of their status or if it is cost-effective.
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Comparative Study Clinical Trial
ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections.
Soft tissue infections are a common presenting complaint in the emergency department (ED). The authors sought to determine the utility of ED bedside ultrasonography (US) in detecting subcutaneous abscesses. ⋯ ED bedside US improves accuracy in detection of superficial abscesses.