ED management : the monthly update on emergency department management
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A new study bolsters earlier findings that children who present to the ED with minor blunt head trauma can benefit from a period of observation before physicians decide whether to order computed tomography (CT) scans. Researchers note that the strategy significantly reduces the number of CTs that are required in these cases, reducing the risks associated with exposure to ionizing radiation. In a single-center study, researchers compared children who were observed with children who were not observed prior to CT decisions being made. ⋯ Just 5% of the patients who were observed proceeded to undergo CT scans; 34% of the patients who were not observed underwent immediate CT scans. Researchers note that troubling symptoms such as headache, vomiting, or altered mental status often resolve with time, negating the need for a CT scan. While more than 500,000 children present to EDs in the United States each year with blunt head trauma injuries, very few are found to have significant traumatic brain injuries.
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With funding from the Duke Endowment, the Albemarle Hospital Foundation in Elizabeth City, NC, implemented a telepsychiatry program aimed at decreasing patient backlogs in the health system's EDs, while also quickly connecting patients with needed mental health care. The approach has more than halved LOS for patients who are discharged to inpatient treatment facilities. The approach is also credited with reducing recidivism rates and the need for involuntary commitments. ⋯ Patients in the ED are connected with psychiatric providers at a remote location through the use of telemedicine carts that are equipped with wireless technology. With expedited psychiatric treatment, administrators say that nearly 30% of patients with involuntary commitment (IVC) orders stabilize to the point that their IVC orders can be rescinded and they can be discharged from the ED to outpatient care. Since the start of the pilot program in March of 2011, project administrators report that the average LOS in the ED for patients discharged to inpatient treatment facilities has decreased from 48 hours to 22.5 hours.