Articles: hospital-emergency-service.
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Randomized Controlled Trial Clinical Trial
Prescription noncompliance: contribution to emergency department visits and cost.
We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. ⋯ Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year's medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.
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Randomized Controlled Trial Clinical Trial
Effect of point of care testing on length of stay in an adult emergency department.
Devices are now available that are practical for point of care testing (PCT) in hospital settings. Previous studies in clinical settings, however, have failed to demonstrate a reduction in patients' length of stay (LOS) associated with the use of PCT. This randomized controlled study compared PCT with central laboratory testing in a hospital Emergency Department to assess the difference in patients' LOS. ⋯ The median stay associated with PCT was significantly shorter. Among patients who were destined to be discharged home, there was also a significantly shorter stay, but not among those who were destined to be admitted. It was concluded that the use of PCT can achieve significant time savings in an Emergency Department.
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Health Care Manag Sci · Jul 1999
Randomized Controlled Trial Multicenter Study Clinical TrialThe quick response initiative in the emergency department: who benefits?
This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. ⋯ The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total "exclusion" group, 37 refused Home Care services including the QRP. HEALTH CARE PRACTICE IMPLICATIONS: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial of template-assisted versus undirected written recording of physician records in the emergency department.
To determine whether use of the T-System (Emergency Services Consultants, Irving, TX) template-generated medical documentation system (1) decreases physician evaluation time in the emergency department, (2) increases gross billing under the 1997 Health Care Financing Administration guidelines by minimizing downcoding caused by inadequate documentation, and (3) increases physician satisfaction with the documentation process, compared with the undirected written narrative format. ⋯ Use of template-assisted documentation in the ED was associated with higher gross billing and physician satisfaction but no significant decrease in emergency physician total evaluation time.
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Randomized Controlled Trial Clinical Trial
Effect of continuously nebulized ipratropium bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm. A randomized, controlled trial.
To compare the outcome of patients with acute bronchospasm treated with continuously nebulized albuterol plus ipratropium bromide vs albuterol alone. ⋯ Although the direction of all three outcome measures favored combination therapy, there was no statistically significant difference between ED patients with acute bronchospasm receiving continuous albuterol plus ipratropium bromide and those receiving albuterol alone.