Articles: emergency-services.
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Journal of medical ethics · Jun 1993
Postmortem procedures in the emergency department: using the recently dead to practise and teach.
In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients?
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Qual Assur Health Care · Jun 1993
Improving quality in emergency services to reduce hospital admission.
At the Emergency Department of Udine General Hospital (Italy) a programme to reduce admissions to the Internal Medicine Department was introduced in 1991. The majority of these admissions come from the Emergency Department, where many people, often without acute conditions, claim medical care. The programme consisted in organizational, professional and economic changes. ⋯ Finally, examinations for internal medical complaints in the emergency ward, not followed by hospitalization, increased by 15.5%. These results showed a reduction in admissions to the Internal Medicine Department greater than previously planned, with an increase in the number of outpatient examinations in the emergency room not followed by admission. Further targets were planned for 1992 to increase the quality of the service.
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Health services research · Jun 1993
Comparative StudyMeasuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.
This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. ⋯ The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services.
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Pediatric emergency care · Jun 1993
General trauma in a pediatric emergency department: spectrum and consultation patterns.
To assess the consultation patterns of pediatric emergency physicians in the management of injured children and to describe the spectrum of pediatric trauma, we retrospectively reviewed 601 patients treated in the emergency department for injuries during four one-week periods at a designated level I regional pediatric trauma center (50,000 patients/year) with a pediatric emergency medicine fellowship. The majority (94%) of pediatric trauma was minor; only 2% of children had injuries severe enough to require direct transfer to the operating room. The highest volume of patients, the greatest number of consultations, and the majority of admissions to the operating room occurred between 4 PM and midnight. ⋯ One half of all procedures involved laceration repair, and one third involved splinting or casting. Four hundred ten patients (68%) were managed by physicians in the emergency department without consultation. The orthopedic service performed one half of all consultations and admitted the largest number of patients; the majority of patients taken directly to the operating room had musculoskeletal injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine the use pattern of the emergency department by people 65 years of age and older. ⋯ Elderly persons do not misuse the services of the emergency department. They come because they are acutely ill; they are not frequent attenders, and their presenting complaints do require intervention (frequently hospitalization). The study findings are generalizable to the older population in the Hamilton-Wentworth region and raise such questions as whether some hospital admissions could have been avoided by earlier interventions in the community.