Articles: hospital-emergency-service.
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Comparative Study
Emergency department utilization during a doctors' strike.
Emergency department (ED) patient volume at Jerusalem's Shaare Zedek Hospital was 33% higher during the 1983 doctors' strike as compared with the same period in 1982. Excess visits were recorded for both sexes (P less than 0.0001), but there were many more excess visits by females than males. ⋯ In contrast to excess ED visits, which were higher during the strike for both sexes, excess hospital admissions via the ED were recorded only among females (P = 0.007). The number of ED visits during the strike was increased on all three hospital work shifts (P less than 0.0001), with the greatest number of excess visits occurring between 7 AM and 3 PM.
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To evaluate the effectiveness of the trauma care system in the Hudson Valley Emergency Medical Services (EMS) Region, (with no designated regional trauma care center) 421 consecutive trauma autopsy reports for 1979-80 were analyzed. Of the 421 trauma patients, 194 died at the scene (DAS), most from vehicular accidents. The remaining 227 patients were triaged into the EMS system. ⋯ Nearly 60 per cent of the deaths involved brain injuries. A panel of five physician-evaluators examined the pathologist's analysis of those deaths considered to have been possibly preventable and concluded that 10 deaths (7.6 per cent) of in-hospital cases were preventable. The study showed the need for primary prevention of accidents to decrease the number of victims (46 per cent) who died at the scene and those (23 per cent) who were dead on arrival at hospitals.
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Two hundred consecutive cases brought to the attention of a malpractice insurer by evidence of expected legal action were reviewed. Of these cases, 132 (66%) were attributed primarily to misdiagnosis, and 87 of these would have satisfied admission criteria. The most common error was grossly deficient examination relating to the chief complaint. Focused attention to physical examination and diagnostic skills, history taking, and minimal use of laboratory studies could have avoided the initiation of the majority of cases.