J Emerg Med
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Review
Understanding the Value of Emergency Care: A Framework Incorporating Stakeholder Perspectives.
In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. ⋯ The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care.
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Multicenter Study
Identifying Frequent Users of Emergency Department Resources.
There is growing focus on frequent users of acute care resources. If these patients can be identified, interventions can be established to offer more consistent management plans to decrease inappropriate utilization. ⋯ A community-wide identification method resulted in greater numbers of individuals being identified as frequent and super ED users than when utilizing individual hospital data.
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Review Case Reports
Acute Spontaneous Subdural Hematoma in a Middle-Aged Adult: Case Report and Review of the Literature.
Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature. ⋯ Given the rarity of SDH in nonelderly patients, this case suggests a broader differential diagnosis for nontraumatic headaches to include arterial and even neoplastic origins. Our literature review confirms the paucity of reported incidences of ASSDH, yet reminds medical providers to closely monitor for developing neurological symptoms and initiate prompt medical intervention when necessary.
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Children's pain is frequently underrecognized and undertreated. This study focuses exclusively on children's perspectives of and satisfaction with their pain management in the emergency department (ED). ⋯ Despite continued pain upon discharge, most children were satisfied with their pain management. However, it is important that emergency physicians not interpret patient satisfaction as equivalent to adequate provision of analgesia. The relationship between children's pain management and self-reported satisfaction needs to be further explored.
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In the emergency department (ED), hyperkalemia in the presence of hemolysis is common. Elevated hemolyzed potassium levels are often repeated by emergency physicians to confirm pseudohyperkalemia and to exclude a life-threatening true hyperkalemia. ⋯ In the setting of hemolysis, GFR ≥ 60 mL/min in conjunction with a normal ECG is a reliable predictor of pseudohyperkalemia and may eliminate the need for repeat testing. In patients with a normal GFR who are otherwise deemed safe for discharge, our results indicate there is no need for repeat testing.