Articles: hospital-emergency-service.
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Administrators at Mercy Hospital in Springfield, Massachusetts, studied the effects of daily patient number and arrival rate on waiting time in the Emergency Unit. These two factors were found to have a smaller impact on waiting times than might be expected. Several issues relating to staffing and to patients' illnesses were addressed to reduce visit lengths (ie, inadequate number of admitting registrars, inefficient use of staff, insufficient locations for the rapid treatment of patients requiring suturing, and large numbers of ancillary services requested on a stat basis). Subsequent studies showed that changes instituted as a result of the initial study had reduced overall emergency waiting time by 12%, even though average daily census had increased by 17%.
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The charts of 33 consecutive patients undergoing emergency department thoracotomies between July 1, 1979 and June 30, 1980 were reviewed. Thoracotomies were performed in victims of both blunt and penetrating trauma who had suffered cardiopulmonary arrest and were refractory to the usual methods of resuscitation. ⋯ There were no survivors from blunt trauma or penetrating wounds below the diaphragm. In patients with penetrating wounds above the diaphragm, emergency thoracotomy may be considerable benefit as demonstrated in our study by a 66.6% salvage rate.
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Comparative Study
Geriatric psychiatry in the emergency department: characteristics of geriatric and non-geriatric admissions.
A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle-aged (40-64 years old) patients seen in an urban hospital's psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self-referred. ⋯ Access to treatment was fairly consistent for both groups as measured by the hospital's priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency-department medical clearance of elderly patients with symptoms of organic brain syndrome.
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A six-bed observation ward has been an integral part of our community hospital emergency department for 10 years. During a recent 4-month period, 574 patients were admitted with 65 different clinical presentations. ⋯ Guidelines have been developed which avoid most potential pitfalls in the use of an observation ward. Significant flexibility is gained and improved patient care is possible with the addition of an observation ward to the emergency department.