Articles: emergency-services.
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The re-siting of the Tameside General Hospital accident and emergency department in a new, custom-built facility acted as the impetus for the formal introduction of the triage system of care. Ron Gray outlines the process of introduction and stresses that while problems have been encountered, the indications are that the system has worked to the benefit of patients and nurses.
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Case Reports Randomized Controlled Trial Clinical Trial
Improving the use of early follow-up care after emergency department visits. A randomized trial.
To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner. ⋯ The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.
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Pediatric emergency care · Apr 1991
The spectrum and frequency of illness presenting to a pediatric emergency department.
Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for physicians treating children in emergency departments. To provide these data, we reviewed the records for four one-week periods (January, April, July, and October) of a large pediatric emergency department to describe the population in terms of age, chief complaints, diagnoses, time of arrival, seasonal variation, and disposition. There were 3796 log entries. ⋯ More than half of the patients arrived on the evening shift, between 4 pm and 12 am. Eleven percent of the children seen on day and evening shifts and 13% from the night shift were admitted. From the analysis of our data we recommend expanded skills in the management of minor trauma for pediatric residents, an emphasis on management of infections for nonpediatric emergency specialists, and extensive training in both pediatric and adult trauma for physicians in pediatric emergency medicine fellowships.
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A disaster that produces a multitude of patients may severely stress a community's health-care system, from the EMS system to the hospitals. Physicians involved in such an event must realize that they will have to change their normal mode of delivering care, having to make decisions with less than the normal amount of information, and doing the most good for the most salvageable patients. Some understanding of and appreciation for the unique problems that face emergency personnel in the field are important for physicians who do not normally interact with fire and EMS personnel, because it will allow them to realize that they are not alone in the chaos of a disaster. ⋯ Hospital physicians can do much to prepare themselves for these eventualities. Discussion and planning should be done among separate staffs (ICU, operating suite, emergency department), as well as among staff of the various disciplines so they can interact more effectively when a disaster occurs. Local disaster planners should receive input from hospital staffs so hospital capabilities are known and the field operation can mesh well with the hospital's operation.
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A review of emergency department visits during a 2-year period and before and after the liberation of physicians from a requirement of gatekeeping for some patients during the night showed no significant increases in the use or costs of services to our Medicaid enrollees for all but children under 6 years of age between 10 PM and midnight. We recommend that a more humane and practical view be taken of middle-of-the-night gatekeeping requirements for physicians functioning in managed-care environments. We also suggest, as many hospitals have already learned, that the costs of emergency department services for Medicaid patients can be reduced and that care may be enhanced by the offering of 24-hour urgent care services at or near the emergency department.