Articles: emergency-services.
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To determine the scope and magnitude of patient and visitor aggression directed toward emergency department staff. ⋯ ED violence is a significant and under-reported problem at our medium-sized university teaching hospital. These data are useful in objectively quantifying the scope of violence in our institution, and they underscore the potential risk to emergency patients, visitors, and staff. There is an acute need for additional studies in other settings so that appropriate and cost-effective security recommendations can be formulated.
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Hospital and emergency department overcrowding is a serious and growing problem nationwide. Although EDs are organized around the goals of rapid patient assessment, stabilization, and prompt admission to the hospital, an increasing number are being required to hold admitted floor and critical care patients for extended periods due to lack of vacant inpatient beds. ⋯ The initial focus of management strategies to resolve this problem is the inpatient area and includes evaluation of length of stay, "intent to discharge" policies, flexible bed designations, restriction of in-house transfers, and the use of "over-census beds." If in-hospital management strategies fail, modifications in ED management may include staffing contingency plans, definition of physician responsibility, inpatient charts, revised pharmacy formulary, new floor plans, and modified accounting systems. Successful resolution of hospital and ED overcrowding may be the greatest challenge facing emergency medicine today.
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In response to recent reports questioning the adequacy of management of major trauma in the United Kingdom, the routine for handling such emergencies in one district general hospital was examined. Deficiencies in the current system of management were identified and are described. In order to improve the standard of care a protocol for the assessment and resuscitation of the seriously injured was devised. ⋯ In addition, a new form of documentation was designed to facilitate the recording of injuries, resuscitation measures required and physiological parameters. This documentation is described in detail. These measures have been favourably received by medical and nursing staff and have stimulated interest in the management of major injuries.