Articles: emergency-medicine.
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The twin goals of health care reform--providing universal coverage and limiting health care costs--will require increased primary care access and reductions in the overuse of inappropriate subspecialty interventions. The emergency department provides acute care access for all patients and nonemergency care for those patients unable to find other sources of care. ⋯ These two effects may endanger the viability of the ED as the safety net of the health care system. The impact of health care reform on the emergency care system of the nation requires careful analysis to protect the important role of the ED in providing acute care and in guaranteeing access to care.
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Comparative Study
Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level.
Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. ⋯ Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.