Articles: emergency-services.
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Qual Assur Util Rev · Jan 1991
GuidelineThe rational ordering of blood cultures in the emergency department.
A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and patients. ⋯ Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and admission to the hospital. This study reviews the manner in which blood cultures were ordered before and after the introduction of general guidelines for their use. It outlines a process whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other laboratory and diagnostic studies.
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Investigative radiology · Jan 1991
The current status of faculty staffing and resident training in emergency radiology. Results of a survey.
The results of a survey of United States and Canadian radiology residency programs in hospitals maintaining major emergency departments indicate that (1) radiologic faculty assignment to emergency medicine may include "all faculty," "specific faculty," "specific and other faculty," "general," and "musculoskeletal" faculty; (2) a chief of emergency radiology section is designated in less than 35% of radiology departments providing emergency room services; (3) radiology resident rotation in emergency radiology occurs in less than 2/3 of the surveyed programs; and (4) radiology resident experience in emergency radiology ranges from two to 16 weeks in 40% of these programs, the remainder being "unspecified." The effect of this circumstance upon the emergency department patient care and resident teaching in emergency radiology is discussed and remedial suggestions presented.
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Primary health care in the accident and emergency department has been a philosophy of care that reacts to more than a client's presenting complaint (reactive care). It aims not only to manage the presenting complaint, but also to integrate continuing care with disease prevention and health promotion. Primary health care in the AED is intended to build fences around the cliffs forming our healthcare problems. At the same time it also encourages the provision of intensive care ambulances for those clients unfortunate to fall before the fences are finished or who fall over the fences.
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The Quick Response Team, consisting of physicians, nurses and social workers in an emergency room setting, conducted a five month pilot project whose overall goal was to eliminate unnecessary admissions to an acute care hospital. This paper reports on the three social work objectives of the program: high risk screening and direct intervention, including assessment, short-term counselling, information, and referral; follow-up services; and social work coverage to all units after hours. Over a 4 month period 11.6% of all patients in the emergency room were assessed by the social work staff and 24 non-acute admissions were deferred. The results of the study confirm the effectiveness of a social work presence in the emergency department in reducing non-acute admissions and in providing continuity of care for patients at high social risk.
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Webster defines process as a "series of actions or operations conducting to an end." Each of the many processes that may be involved with providing a service or procedure comprises many smaller steps. It is the monitoring of those steps that we call a process review. The process review for quality management begins when a patient perceives the need to receive emergency care. It embodies the technical and interpersonal aspects of the patients, and the staff's interpersonal relationships.