Articles: hospital-emergency-service.
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The urban emergency department is routinely asked to manage not only medical emergencies, but also a great variety of social emergencies. This situation is caused in part by budgetary constraints which prevent other agencies from providing 24-hour coverage. ⋯ A case is presented which raises the issues of confidentiality and liberty in the fiduciary relationship between doctor and patient. The concept of personal care is found to be paramount.
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Because asthmatics have the highest utilization rate (11%) kin our emergency department (ED) observation unit (OU), we conducted a study correlating predictors of the need for OU therapy to initial disposition (ID) and final disposition (FD) using chart audit of treated asthmatics. Twenty-four clinical variables. (historical, physiological, laboratory, therapy response) were examined utilizing chi-square and Student's t tests. Forty-six asthmatics were treated during a four-month period in 1980. ⋯ Clinical variables correlating significantly with definitive therapy based on ID and FD were historical; symptoms greater than 24 hours, prior OU admissions, and prior hospitalizations. We conclude that the OU is appropriate, safe, and less expensive than admission; is not used for procrastination in decision making and decreases the hospitalization rate. Historical data correlated significantly with both ID and FD, while clinical variables were of little predictive value.