Articles: emergency-medicine.
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We anticipate that over the next few years, emergency physician use of emergency department ultrasound will become the standard of care. However, many EDs are hampered in their efforts to gain hospital approval for emergency physician use of ultrasound because of the lack of publicized information regarding the goals of such use, the scope of emergency physician ultrasound privileges, emergency physician ultrasound credentialing criteria, and ED ultrasound quality-improvement plans. In this article we address these issues and provide an example of a proposal used successfully to gain hospital approval for ED use of ultrasound by emergency physicians.
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For physicians working in emergency departments, optimum management of patients with arrhythmias is an important skill. To assess the learning needs of Canadian emergency physicians with respect to arrhythmias, the members of the Canadian Association of Emergency Physicians (CAEP) were surveyed. The survey assessed perceived learning needs and included 11 scenarios assessing physician knowledge. ⋯ The topic areas ranked most highly by respondents in terms of perceived learning needs were management of ventricular arrhythmias (especially electrical strom), and clinical use of oral and intravenous antiarrhythmic drugs, particularly the clinical use of intravenous amiodarone. The assessment of knowledge showed that the respondents managed most arrhythmias in accordance with published guidelines, although the management of some wide complex tachyarrhythmias was not optimal. These results will be used to guide an ongoing program of continuing medical education.
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The purpose of this study was to determine the levels of agreement between three methods of assessing appropriateness of emergency department (ED) visits. In particular, we tested the agreement between internists and emergency physicians reviewing the ED nurses' triage notes, containing information that might be available by telephone to an internist. ⋯ In cases of disagreement, emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED care. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on access to timely care in office settings.
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An educational program that teaches undergraduate students about clinical research related to emergency medicine is described. The students work as research assistants within the ED, thus providing a departmental framework for the enrollment of patients in clinical studies. Volunteers interested in the program undergo a physical examination, vaccination history, and standard serologic testing, and sit through a formal blood and body fluid exposure course offered by the university prior to their clinical research participation. ⋯ While there was only 1 faculty member with a research publication in 1992, there were 9 faculty with manuscripts accepted for publication in the first 6 months of 1996. Similarly, more nurses and ancillary staff have become involved in prospective clinical research. Much of this success is attributed to the novel use of resources through the academic associate program.