Emergency medicine journal : EMJ
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to determine the efficacy of the fascia iliaca block in providing analgesia to patients with a proximal femoral fracture in the emergency department. ⋯ the fascia iliaca block could have an important role in first-line pain control for patients presenting to the emergency department with a proximal femoral fracture. There is potential to reform the acute management of this common group of patients.
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Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. ⋯ From the health-economic point of view, our new service model shows 'dominance' over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.
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Making an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is conveyed in a succinct manner to the correct inpatient specialty. The aim of this study was to assess: the impact of grade of staff making the referral; specialty referred to; and condition or patient problem. It also aimed to identify current problems or barriers in the referral process. ⋯ There are differences in understanding and opinion between ED and non-ED staff about the referral process. There are also factors which influence ease of referral: specialty referring to and patient problem. More intervention studies are required to identify solutions that can be implemented and sustained in routine practice.
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To compare children's pathways to and through Community Children's Nursing Team (CCNT) care, and NHS costs, before and after relocation of inpatient services and extension of a paediatric Emergency Department and Observation and Assessment Unit (ED/OAU). ⋯ A CCNT provided an alternative to hospitalisation when acute general paediatric services were reconfigured to substitute for a relocated hospital. Children's pathways to CCNT care were shortened. The average cost of CCNT care and overall NHS cost were lower following reconfiguration. Satisfaction remained high throughout.
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Observational Study
Agreement between mathematically arterialised venous versus arterial blood gas values in patients undergoing non-invasive ventilation: a cohort study.
Blood gas analysis is important for assessment of ventilatory function. Traditionally, arterial analysis has been used. A method for mathematically arterialising venous blood gas values has been developed. Our aim was to validate this method in patients undergoing non-invasive ventilation (NIV) in an emergency department (ED). ⋯ For patients undergoing NIV in an ED, agreement between mathematically arterialised venous values and arterial values was close for pH but only moderate for pCO2. Depending on clinician tolerance for agreement, this method may be a clinically useful alternative to arterial blood gas analysis in the ED.