J Emerg Med
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The objective of this study was to implement a system of continuous quality improvement to reduce delays in the administration of thrombolytic therapy for patients with acute myocardial infarction in the emergency department (ED). The setting was a community hospital ED with an annual census of approximately 40,000 patients. The participants included all patients presenting to the ED with a diagnosis of acute myocardial infarction eligible for thrombolytic therapy. ⋯ In the postintervention period, the performance level of the new process was evaluated and the results were compared with those in the preintervention period. In the postintervention period, the median elapsed time from ED admission to thrombolysis was 40 min, which was significantly shorter that the median preintervention time of 62 min. This study successfully applied the theory of continuous quality improvement to reduce the delays to thrombolytic therapy for patients with acute myocardial infarction in the ED.
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A telephone questionnaire examining perceived quality of and satisfaction with Emergency Department (ED) care was administered to randomly selected patients within 60 days of their visit to a university hospital ED over a 13-month period. Patients, or the persons who accompanied them to the ED, rated overall service, nursing technical performance, physician technical performance, nursing bedside manner, physician bedside manner, and registration clerk service on a 5-point rating scale (5 = excellent, 4 = very good, 3 = good, 2 = fair, 1 = poor). ⋯ A total of 618 interviews were conducted (1333 attempts to contact, 12 people declined to be interviewed). The results suggest that patient perceptions of the technical quality of care are more important than perceived timeliness of care or bedside manner in determining patient satisfaction with ED care.
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The study evaluated the impact of rotational assignment of emergency department (ED) patients to residents on patient's length of stay (LOS) and resident satisfaction. The study was conducted in a university, inner-city, adult ED. Prior to the intervention, residents saw patients at their own rate as patient charts were placed into a common rack waiting to be seen. ⋯ During the same periods, the average total LOS increased significantly for the surgical patients. Residents reported that the new system was more fair and did not affect teaching quality. The rotational assignment of patients to resident physicians led to significantly less ED LOS while improving resident satisfaction without affecting education.
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Aeromonas is increasingly recognized as a human pathogen that causes a variety of different infections. Aeromonas has rarely been reported as a cause of respiratory infection, and it has been described in near-drowning-associated pneumonia. This article reviews a case of Aeromonas sobria pneumonia associated with a near drowning and considers the clinical and epidemiological characteristics of 10 previously reported cases. ⋯ A very high rate of positive blood cultures and mortality was also noted. The epidemiological and clinical data in this review may be helpful to the clinician caring for near-drowning victims. Although prophylactic antibiotics are not recommended for near-drowning victims, broad-spectrum antibiotics should be rapidly instituted with any evidence of infection.