Emergency medicine journal : EMJ
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Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management. ⋯ We decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.
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To determine the relative importance members of the US public place on different patient attributes in triage decisions about who should receive the last available intensive care unit (ICU) bed. ⋯ Respondents favoured giving the last ICU bed available to the patient with the highest probability of surviving COVID-19. Public opinion suggests a simple guideline for physician choices based on likelihood of survival as opposed to the number of life-years saved. There was heterogeneity among respondents of different age groups for allocating the last ICU bed, as well as to the importance of the patient having an Alzheimer's-like disability (where religion of the respondent is important) and the gender of the patient (where the gender and racial identity are important).
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Multicenter Study
Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data.
Frequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system. ⋯ ED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders.
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Incivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered 'part of the job'. ⋯ This study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.