J Emerg Med
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Variability exists in emergency physician (EP) resource utilization as measured by ordering practices, rate of consultation, and propensity to admit patients. ⋯ At our academic tertiary center, 3 distinct subgroups of EP ordering practices exist based on consultation rates, advanced imaging use, and propensity to admit a patient. These data validate previous work showing that resource utilization and admission rates are related, while demonstrating that more nuanced patterns of EP ordering practices exist. Further investigation is needed to understand the impact of EP characteristics and behavior on throughput and quality of care. © 2022 Elsevier Inc.
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How much of a role should personal responsibility play in triage criteria? Because voluntarily unvaccinated people are not fulfilling their societal obligations during a pandemic, the ethical principle of justice demands that they reap the egalitarian consequences. These consequences could include lower priority for care, an increasing number of employer and government mandates, and restrictions to entering many entertainment venues. ⋯ A method to balance resource allocation between those patients who refuse vaccination and patients who need the same health care resources is necessary. An ethical solution is to give those who are voluntarily unvaccinated a lower priority for admission and for the use of other health care resources. Current in-hospital triage models can easily be modified to accomplish this. This substantive change in practice may encourage more people to get vaccinated.
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Dr. Patrick Lowe: Our case today is that of a 47-year-old woman who was referred to our emergency department (ED) due to bloody urine, dark tarry stools, red spots on her skin, and bruising throughout her body. Fourteen days prior to presentation, she began exhibiting intermittent fevers, headache, shortness of breath, and a dry cough, and she tested positive for SARS-CoV-2 (the virus that causes COVID-19 pneumonia). ⋯ In addition, she had multiple dark stools described as tar-like when asked. On the day of her ED presentation, the patient noted a red rash throughout her body. In addition, earlier in the day, she had atraumatic self-limited epistaxis. She denied any falls or head strikes, vision changes, focal weakness or numbness, shortness of breath, chest pain, abdominal pain, or peripheral swelling.