Articles: hospital-emergency-service.
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Pediatric emergency care · Feb 2022
Optimizing Critical Care Documentation in a Pediatric Emergency Department.
Emergency department (ED) physicians frequently provide critical care (CC) but document inconsistently. Variability in documentation can result in underbilling and is inconsistent with financial stewardship. We used admissions to the intensive care unit (ICU) as a proxy for CC provision. At baseline, CC notes were correctly documented for 20% of eligible visits, with potential missed charges of $1.8 million per year.Our objective was to increase CC note placement for eligible patients from 20% to 60% over 2 years. Additionally, we measured CC notes and the number of ICU admissions per 1000 ED visits, and change in facility fees. ⋯ This project resulted in significant and sustained improvements in CC note completion. We believe providing education, simplifying the documentation process, automating reminders, and incentivizing optimal documentation were vital to success.
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Emerg Med Australas · Feb 2022
Observational StudyExamining emergency department inequities in Aotearoa New Zealand: Findings from a national retrospective observational study examining Indigenous emergency care outcomes.
There is increasing evidence that EDs may not operate equitably for all patients, with Indigenous and minoritised ethnicity patients experiencing longer wait times for assessment, differential pain management and less evaluation and treatment of acute conditions. ⋯ To our knowledge, this is the most comprehensive investigation of acute outcomes by ethnicity to date in New Zealand. We found ED mortality inequities that are unlikely to be explained by ED process measures or comorbidities. Our findings reinforce the need to investigate health professional bias and institutional racism within an acute care context.
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Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access. ⋯ Adding one transporter provided the greatest combination of reduced delay and ability to implement. The projected simulation improvements have been realized in practice.
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Pediatric emergency care · Feb 2022
Point-of-Care Ultrasound for the Evaluation of Neck Masses in the Pediatric Emergency Department: A Case Series.
Point-of-care ultrasound can be an effective tool for pediatric emergency medicine providers in the evaluation of soft tissue lesions. We present a series of 4 pediatric patients with neck lesions in whom point-of-care ultrasound identified the type of lesion, guided decision-making on the need for computed tomography imaging, and led to definitive management.
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Emerg Med Australas · Feb 2022
'Dalarinji': A flexible clinic, belonging to and for the Aboriginal people, in an Australian emergency department.
Equity and access to high-quality healthcare for Aboriginal and Torres Strait Islander (Aboriginal) people has remained refractory for complex and multifactorial reasons, and there are sound ethical arguments for addressing this urgently. In EDs all patients who 'leave at own risk' (LAOR) or 'do not wait to be seen' (DNW) are at increased risk of readmission, morbidity or death. This also incurs additional resource costs to the health system. Aboriginal patients have high rates of DNW and LAOR. The Flexiclinic model of care was co-designed to better support the needs of Aboriginal patients in the ED and to reduce the rates of DNW and LAOR. ⋯ The Flexiclinic approach has significantly improved medical care at SVHED for Aboriginal patients. It has been well received by both staff and patients and has had no adverse effects on delivery of services to other patient groups.