Articles: emergency-department.
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ABSTRACTObjectives:The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. Methods:A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. ⋯ Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. Conclusion:PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.
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Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. ⋯ Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes.
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Overcrowding in the emergency department (ED) is an increasing problem worldwide. In The Netherlands overcrowding is not a major issue, although some urban hospitals struggle with increased throughput. In 2004, Weiss et al. created the NEDOCS tool (National Emergency Department Over Crowding Study), a web-based instrument to measure objective overcrowding with scores between 0 (not busy at all) to above 181 (disaster). In this study we tried to validate the accuracy of the NEDOCS tool by comparing this with the subjective feelings of the ED nurse and emergency physician (EP) in an inner city hospital in The Netherlands. ⋯ The NEDOCS tool is a reasonably good tool to quantify the subjective feelings of overcrowding. When overcrowding is encountered and immediately recognised, specific measures can be taken to guarantee the timely provision of necessary medical care to the patients in the ED at that time. However, possibly more accurate agreements could be obtained as approximately 20% of the surveys were not completed because of perceived crowdedness. An important limitation is that only 3% of the NEDOCS is scored as overcrowded, so no conclusions can be drawn about the agreement for higher categories of overcrowding. It is suggested to repeat the study in a busier period. As the triage category was not taken into account in the formula, a high workload with only a few patients giving high scores in subjective overcrowding in spite of a low NEDOCS score could have led to lower agreements. Incorporating the triage category in the NEDOCS tool possibly will lead to better agreement, but further research is needed to assess this idea.
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ABSTRACTObjective:To determine the willingness of parents of children visiting a pediatric emergency department to have a physician assistant (PA) assess and treat their child and the waiting time reduction sufficient for them to choose to receive treatment by a PA rather than wait for a physician. Method:After describing the training and scope of practice of PAs, we asked caregivers of children triaged as urgent to nonurgent if they would be willing to have their child assessed and treated by a PA on that visit: definitely, maybe, or never. We also asked the minimum amount of waiting time reduction they would want to see before choosing to receive treatment by a PA rather than wait for a physician. ⋯ Most respondents (64.1%) would choose to have their child seen by a PA instead of waiting for a physician if the waiting time reduction were at least 60 minutes (median 60 minutes [interquartile range 60 minutes]). Respondents' perception of the severity of their child's condition was associated with unwillingness to receive treatment by a PA, whereas child's age, presenting complaint, and actual waiting time were not. Conclusion:Only a small minority of parents of children visiting a pediatric emergency department for urgent to nonurgent issues are unwilling to have their child treated by PAs.