Articles: hospital-emergency-service.
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Meta Analysis
Delirium screening tools in the emergency department: A protocol for systematic review and meta-analysis.
Delirium is a common type of acute brain dysfunction among emergency department (ED) patients. The prevalence of delirium in the ED is up to 40%. Although screening instruments used to identify delirium have been developed, it is unclear which tool is the most accurate in the ED. To address this challenging, we systematically examine the accuracy of delirium screening tools used to assess the ED patients. ⋯ According to the conclusion of the systematic review, evidence will be provided to judge which screening method is the best for the ED patients. The results will bring better understanding of screening methods in the ED and highlight gaps for future research.
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Review Meta Analysis
Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis.
Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting. ⋯ Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use.
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Meta Analysis
Machine Learning versus Usual Care for Diagnostic and Prognostic Prediction in the Emergency Department: A Systematic Review.
Having shown promise in other medical fields, we sought to determine whether machine learning (ML) models perform better than usual care in diagnostic and prognostic prediction for emergency department (ED) patients. ⋯ Our review suggests that ML may have better prediction performance than usual care for ED patients with a variety of clinical presentations and outcomes. However, prediction model reporting guidelines should be followed to provide clinically applicable data. Interventional trials are needed to assess the impact of ML models on patient-centered outcomes.
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Failure to provide adequate discharge advice to patients on leaving the emergency department can lead to poor understanding of and noncompliance with discharge instructions and consequently postdischarge complications or hospital readmissions. The use of pictographs to complement discharge advice has the potential to enhance patient recall and comprehension. The purpose of this paper was to determine the effectiveness of pictorial discharge advice compared with standard discharge advice in the emergency department. ⋯ The results of this systematic review support the use of pictorial discharge advice. However, few studies exist; none had a low risk of bias overall, and 3 were published over 12 years ago. This finding highlights a need for further research to inform evidence-based best practices on optimal methods for providing quality discharge advice in the emergency department.
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Emerg Med Australas · Dec 2020
Review Meta AnalysisReview article: Pre-hospital provider clinical judgement upon arrival to the emergency department: A systematic review and meta-analysis.
Pre-hospital providers (PHPs) undertake initial patient assessment, often spending considerable time with patients prior to arrival at ED. However, continuity of this assessment with ongoing care of patients in the ED is limited, with repeated assessment in the ED, starting with the process of triage in hospital. A systematic review of the literature was conducted to assess the ability of PHPs to predict patient outcomes in the ED. ⋯ Triage score application had weighted kappa variables of 0.409 and 0.452 indicating moderate agreement on assessment priority between PHPs and triage nurses. The ability of PHPs to assign triage scores, predict clinical course and predict disposition from the ED have mild concordance with clinical assessment by ED staff. This is an area of potential expansion in PHPs' role; however, training would be required prior to implementation.