European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
The First View Concept: introduction of industrial flow techniques into emergency medicine organization.
The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. ⋯ After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management.
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Digit preference bias has previously been described in a number of different clinical settings including the emergency department. This study aimed to assess whether the implementation of a computerised recording system affects the digit preference bias in recording of times of arrival, assessment and departure at an emergency department. ⋯ The introduction of the patient tracking system eliminated the digit preference bias found in recording of the time of nursing assessment, examination and departure that was present in the preintervention data.
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Despite the severity of pneumonia in patients with pandemic influenza A infection (H1N1), no validated risk scores associated with H1N1 pneumonia were tested. In this prospective observational study, we analyzed data of consecutive patients in our emergency room, hospitalized because of pneumonia between July and August 2009 in a public hospital in Brazil. The following pneumonia scoring systems were applied: the SMART-COP rule; the Pneumonia Severity Index; and the CURB-65 rule. ⋯ Among them, only 9.5% that had a low risk according to SMART-COP were admitted to ICU, compared with 36.8% of those with the Pneumonia Severity Index score of 1-2 and 49% of those with CURB-65 score of 0-1. The SMART-COP had an accuracy of 83% to predict ICU admission. The SMART-COP rule presented the best performance to indicate ICU admission in patients with H1N1 pneumonia.
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Letter Case Reports
Bronchobiliary fistula: a rare cause of acute dyspnea in emergency department.