Articles: hospital-emergency-service.
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Emergency ward doctors and nurses define patients whose illnesses require prolonged and comprehensive care as threats to the mission of the ward. Data were collected by means of direct observation and interviewing of emergency ward doctors and nurses in a 600-bed hospital in the Midwestern United States. In 1973, a total of 270 hours of observational data was collected as part of a larger study of emergency ward social organization. ⋯ Since these patients often present behavior problems on the ward, one way for medical staff to cope with such patients is to define these patients as management problems rather than as medical cases to be diagnosed and treated. Success or failure with management problems is no longer based on medical criteria, but upon the outcome of management activities. The most successful outcomes are those where the amount of patient's disruptive behavior and the amount of staff time and resources devoted to the patient are held to a minimum.
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At Brooke Army Medical Center the Emergency Services Section has developed an algorith,-directed triage system to be used by "screeners" who may be basic medical corpsmen but sometimes have had no previous medical experience. After 25 hours of classroom and 120 hours of on-the-job training, the screeners use the algorithms to triage patients into one of three treatment areas in the emergency section or to clinics outside the emergency section during the day and evening. The screeners may consult with a triage physician if the algorithm-directed disposition appears inappropriate, Triage dispositions of 78,822 patient visits during the calendar year 1975 are presented.
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The effectiveness of patient triage by a specially trained registered nurse in the emergency department of an urban county hospital, San Francisco General Hospital, was evaluated over a three-month period. Ambulatory patients thought to have nonemergent illnesses were directed to the Walk-In Service for physician evaluation and treatment; the remainder were seen in the Emergency Service. In three months, 11,329 patients registered for care, and 4,150 (37%) were referred to the Walk-In Service. ⋯ There were no deaths. Error in triage was about equally divided between mistaken diagnosis and underestimated severity of illnes. The overall accuracy of triage was 98%.
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Optimal management of a severely injured child depends upon instant availability of a wide variety of emergency equipment and supplies. Some of these items are not commonly found in trauma rooms designed for adults, and others are required in a range of sizes unique to child care. After a major resuscitative effort the trauma room is a shambles from which it must be restored rapidly to receive the next trauma victim. ⋯ This list was patterned after a similar checklist used in the Emergency Department of the Parkland Hospital in Dallas and was developed for children by the Trauma Committee of the American Pediatric Surgical Association. It has been tested and refined in the Trauma Room of the Children's Hospital, Columbus, Ohio, during a 2-year period in which 100,000 children presented to the emergency department. It should be helpful in any emergency department which receives seriously injured children.