Articles: emergency-services.
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Comparative Study
Quality assurance in the emergency department: evaluation of the ECG review process.
To determine whether the review of emergency department ECGs by cardiologists contributes to the quality of patient care. ⋯ Review of ED ECGs by cardiologists did not affect patient care at our institution.
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This paper reports the results of a retrospective review which analysed emergency admissions and readmissions of elderly patients to a district general hospital. All patients received standard after-care allocated by the community health and social services departments following referral by hospital staff. ⋯ The findings show that the patients randomly allocated to receive the modest domiciliary after-care service were less likely to have another emergency readmission or multiple readmissions. The results suggest that patients over 75 years-of-age, living alone, or having two or more emergency admissions within six months, should have a domiciliary assessment and follow-up after hospital discharge.
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To develop a method for predicting hospital admissions for patients with decompensated chronic obstructive pulmonary disease treated in an emergency department. ⋯ A multivariate model can be used to identify patients with decompensated chronic obstructive pulmonary disease who are unlikely to need hospitalization. This model could be used to select episodes of decompensated chronic obstructive pulmonary disease for treatment at home.
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In our accident service department all trauma radiographs are reported acutely and those misinterpreted by the casualty officers are presented at the daily clinicoradiological conference. We have reviewed this practice over a 6-month period. From over 25,000 patients attending the accident service, 16,246 radiographs were requested and reported. ⋯ However, the incidence of misinterpretation was highest in examination of the fingers, especially in children. We believe that these low figures are principally the result of involving both orthopaedic surgeons and radiologists at the formal daily conference. We regard our system of audit as beneficial to patients' care and anticipate reduced litigation which may offset the increased cost of audit.
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To evaluate factors influencing emergency physician staffing patterns in an important subset of US hospitals. ⋯ Responding institutions included 160 private and 115 public hospitals, 74 of which were Veterans Administration hospitals. Formal medical school affiliation was noted by 86% of responding institutions, and 82 (30%) supported emergency medicine residency programs. Full-time attending emergency physician staffing varied widely, from less than one to more than three FTEs per 10,000 visits; however, mean levels of staffing at public hospitals did not differ significantly from private institutions (2.7 +/- 1.6 vs 2.5 +/- 3.1, respectively; P = .50). Three of four hospitals reported using part-time emergency physician attending but only 33% used nurse practitioners or physicians' assistants. Two thirds of responding hospitals used rotating house officers-in-training. Of note, hospitals that supported emergency medicine residency programs reported significantly higher levels of staffing by housestaff (2.2 +/- 1.8 vs 1.0 +/- 1.2 FTEs/10,000 visits; P less than .0004), but levels of total staffing by full- and part-time attending physicians were virtually identical (2.69 +/- 1.6 vs 2.67 +/- 2.6 FTEs/10,000 visits; respectively; P = .95). Marked variability in levels and patterns of ED staffing at public and teaching hospitals currently exists, but the differences are not explained by hospital ownership. The reasons for such variations and their implications for patient care must be explored.