Articles: emergency-department.
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Leaving before medically advised (BMA) is a significant issue in the US healthcare system, leading to adverse health outcomes and increased costs. Despite previous research, multi-year studies using up-to-date nationwide emergency department (ED) data, are limited. This study examines factors associated with leaving BMA from EDs and trends over time, before and during the COVID-19 pandemic. ⋯ In this study, several demographics, socio-economic, and clinical characteristics were associated with higher incidences of leaving ED BMA. The COVID-19 pandemic also exacerbated BMA rates. These findings highlight the need for targeted interventions to improve patient-provider communication and ED triage efficiency, especially in resource-constrained facilities serving lower-income individuals.
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Background Predicting potential overcrowding is a significant tool in efficient emergency department (ED) management. Our aim was to develop and validate overcrowding predictive models using accessible and high quality information. Methods Retrospective cohort study of consecutive days in the Hospital Italiano de Buenos Aires ED from june 2016 to may 2018. ⋯ Discrimination for the main model had an area under the receiveroperator curve of 0.997 (95% CI 0.994 - 1) in the validation group. Calibration for the model was very high on internal validation and acceptable on external validation. Conclusion The Sustained Critical EDOC predictive model includes variables that are easily obtained and can be used for effective resource management in situations of overcrowding.
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Pediatric emergency care · Dec 2024
Missed Opportunity for Initial Diagnosis in Children With Complex Appendicitis.
Delayed diagnosis of acute appendicitis in children may result in complex appendicitis with appendiceal perforation. Delayed diagnosis can result from missed opportunity for initial diagnosis (MOID) despite medical attention. Studies report MOID of less than 5% in pediatric emergency departments (EDs), but we hypothesized that many MOID occurs outside tertiary care facilities. Our goals were to determine the MOID rate in all presenting facilities in children with complex appendicitis and to identify associated risk factors. ⋯ Missed opportunity for initial diagnosis of complex appendicitis occurs in nontertiary care facilities, is more common in younger children and non-English/Spanish speakers, and is associated with worse outcomes, highlighting the need for interpreters and algorithmic evaluation in nontertiary care facilities.
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Pediatric emergency care · Dec 2024
Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline.
The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition. ⋯ Implementation of a clinical guideline pathway improved provider documentation and history taking, increased referrals to specialist care, and significantly decreased return ED visits within 3 weeks for heavy menstrual bleeding complaints.
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Aims/Background Symptomatic abdominal aortic aneurysms carry significant mortality risk. This is supplemented by the Royal College of Emergency Medicine guidelines which suggest imaging for patients 50 years of age or older presenting with unexplained abdominal, flank, or back pain. This study aimed to evaluate the prevalence and mortality rates of patients with symptomatic abdominal aortic aneurysms in a high-risk population and to assess scanning rates in the accident and emergency department. ⋯ However, this study reveals that scanning rates in the emergency department are low. The encouragement of scanning and improved ultrasound skills among emergency medicine clinicians can reduce missed diagnoses. Additionally, we recommend further studies to assess the mortality rates of emergent abdominal aortic aneurysm presentations.