Articles: emergency-services.
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This study was conducted to explain a more than threefold increase in anticipated patient visits associated with the opening of a separate pediatric emergency department (PED) 2 miles from the nearest general emergency department. Population demographics and data pertaining to visits to other emergency departments were obtained. Parents visiting the new PED were surveyed using a standardized questionnaire. ⋯ We conclude that the increase in visits cannot be accounted for by increases in regional population base only. Anticipated patient volume to a new health care facility should not be based on population demographics only, but on other factors such as user perception of facility. Patient or parent preference should also be considered.
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This study evaluated the nature and efficacy of compliance with emergency department (ED) patient referral recommendations. This was a prospective, nonrandomized, descriptive analysis of all ED patients referred mandatorily to an established urban hospital follow-up network. Compliance was measured by analysis of hospital records determined as appointment completion. ⋯ Patients encountered had higher rates of compliance if female (33.9%), greater than 40 years of age (43.4%), with urgent complaints (46.8%), and if referred to private physicians (37.0%) (P less than .001). Compliance also correlated with the diagnosis of fracture (63.3%) or laceration (45.6%); and specialty referral to obstetrics-gynecology (28.4%) and general surgery (22.4%) consultants (P less than .01). Most patients demonstrate low compliance (28%) with follow-up recommendations, even with a directed ED referral system.
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The approach emergency medical service (EMS) systems take to quality assurance and quality improvement is evolving rapidly. Methods of quality assurance that have been applied to the prehospital care environment are reviewed. Impediments to effective quality assurance strategies are discussed and an overview of the scope of the activities and resources necessary to perform this task is presented. The potential efficacy and limitations of quality improvement in EMS are also discussed.