European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial
A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors.
A small group of frequent visitors to emergency departments accounts for a disproportional large number of total emergency department visits. Previous interventions in this population have shown mixed results. ⋯ Our results indicate that the nurse-managed telephone-based case-management intervention represents a possible strategy to improve care for frequent emergency department users as well as decrease outpatient visits, admission days and healthcare costs.
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Observational Study
Delays in the administration of antimicrobials in the emergency department and the impact of an educational intervention to improve this administration.
The aim of the study was to assess the factors associated with delays in emergency department (ED) antimicrobial administration and to determine whether an educational intervention would reduce the incidence of such delays. ⋯ Older age, multiple agent orders, and dosing ordering pattern showed a significant association with delays in ED antimicrobial administration. An educational intervention to disseminate knowledge of these factors did not result in a reduction in such delays.
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Observational Study
Telestroke: rapid treatment of acute ischemic stroke patients using telemedicine in a Singapore emergency department.
In recent years, telemedicine technology has allowed hospitals without an in-house neurology service access to 24-h neurology consultation from specialized centers, thus paving the way for these hospitals to offer thrombolysis treatment for stroke patients. This article will describe the experience of the study hospital's emergency department (ED) in its use of telemedicine technology to facilitate the rapid treatment of acute ischemic stroke patients. ⋯ Telemedicine is an invaluable tool that enables hospitals without 24-h onsite neurology service to offer emergency thrombolysis to eligible stroke patients, who otherwise will not be able to benefit from this therapy.
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Secondary hazards are an important consideration when dealing with both self-poisoned and chemically contaminated patients. Secondary exposure of hospital staff following the admission of a poisoned patient is relatively rare but potentially serious. Risks usually arise from chemical conversion of a deliberately ingested toxic substance and subsequent offgassing, but there may be toxic substances on the victim or their clothing. ⋯ This paper presents a narrative review that considers some of the more commonly encountered toxic chemicals and situations that may present secondary hazards in hospitals. Risks to staff can be lowered by reducing the potential for, and duration of, exposure wherever possible. Good communication with the first responders at the scene, consultation with experts, decontamination and use of personal protective equipment, together with regular training, can minimize risks in the hospital environment.
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Observational Study
Feasibility of introduction and implementation of the Surviving Sepsis Campaign bundle in a Singapore Emergency Department.
The Surviving Sepsis Campaign has been shown to improve the outcome of patients with severe sepsis or septic shock in Europe and North America. We aim to examine the impact of implementing the severe sepsis resuscitation bundle as part of standard care at the National University Hospital Emergency Department (ED) and assess its feasibility in Singapore. ⋯ There was zero compliance to the severe sepsis resuscitation bundle at baseline. Quality improvement initiatives resulted in better compliance and outcome for patients, showing that such a protocol of management is feasible in a typical Singapore ED.