Articles: emergency-department.
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Pediatric emergency care · Jan 2014
ReviewA comprehensive approach to pediatric injury prevention in the emergency department.
Injury is the leading cause of pediatric mortality and long-term disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a "teachable moment" because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. ⋯ These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts.
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The Journal of urology · Jan 2014
Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges.
Using the Nationwide Emergency Department Sample (NEDS) we examined trends in visits, hospitalization and charges for patients with upper urinary tract stones who presented to the emergency department in the United States. ⋯ Women showed significant annual increases in emergency department visits for upper urinary tract stones. While emergency department charges increased substantially, hospitalization rates remained stable. Greater use of computerized tomography and medical expulsive therapy could be the reasons for this observation, which warrants further study.
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Comparative Study
Influence of the Manchester Triage System on waiting time, treatment time, length of stay and patient satisfaction; a before and after study.
To compare waiting time, treatment time, length of stay (LOS), patient satisfaction and distribution of waiting times over levels of urgency before and after the implementation of the Manchester Triage system (MTS) at an emergency department (ED). ⋯ Implementing MTS on its own is not sufficient to improve efficiency and quality of EDs. More complex interventions including process redesigning that targets various groups of ED patients should be evaluated in the future by using rigorous research designs for quality improvement of EDs.
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To investigate the opinions of Israeli ED nurses as to (1) an expansion of their powers and autonomy in treating commonly presenting ED conditions, (2) whether nurses or physicians should be responsible for giving ED patients necessary information and (3) whether ED nurses should perform triage. ⋯ The study demonstrates that ED nurses are convinced that they need the authority to diagnose and treat commonly presenting ED conditions and perform triage and discharge in order for their department to optimally exploit the resources available to it. The study should promote the development of the emergency nurse practitioner role in Israel and so reduce patient waiting times.
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Venous thromboembolism (VTE) is difficult to diagnose yet potentially life threatening. A low-risk pretest probability (PTP) assessment combined with a negative D-dimer can rule out VTE in two-thirds of outpatients, reducing the need for imaging. Real-life implementation of this strategy is associated with several challenges. ⋯ In spite of excellent compliance with our algorithm, we were unable to reduce imaging for VTE. This may be due to a lower threshold for suspecting VTE and an increase in investigation for VTE combined with a high false positive rate of our D-dimer assay in low-pretest probability patients. This study highlights two common real-life challenges with adopting this strategy for VTE investigation.